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MODERN    ITALIAN    SURGERY 

AND  OLD  UNIVERSITIES  OF  ITALY 


MODERN 
ITALIAN   SURGERY 

AND  OLD  UNIVERSITIES  OF  ITALY 


BY 

PAOLO  DE  VECCHI,  M.D. 

Corresponding  Member  of  the  Royal  Academy  of  Medicine,  Turin; 
Fellow  American  College  of  Surgeons 

Foreword  by  George  D.  Stewart,  M.D. 

President  T^ew  Yor\  Academy  of  Medicine 


WITH  FIFTEEN  FULL  PAGE  ILLUSTRATIONS 


NEW  YORK 
PAUL  B.  HOEBER 

MCMXXI 


Copyright,  1921 
By  PAUL  B.  HOEBER 


Published,  September,  1921 


Printed  in  the  United  States  of  America 


DEDICATED 

TO   THE   MEMORY   OF 

GIUSEPPE   DE  VECCHI,    M.D. 

MY  BELOVED   FATHER 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons  (for  the  Medical  Heritage  Library  project) 


http://www.archive.org/details/modernitaliansurOOdeve 


FOREWORD 

For  some  years  prior  to  the  recent  great  war  Ameri- 
can medical  students  have  gone  to  Germany  for  their 
post-graduate  medical  teaching:  France,  England  and 
Austria,  before  this,  having  held  the  honor  in  turn. 
To  Italy  Americans  have  travelled  to  see  art  and  ruins 
but  never  to  visit  the  hospitals  or  to  learn  from  Italy's 
medical  teachers.  Not  that  the  world  in  general,  or 
America  in  particular,  was  unaware  of  the  reputation 
of  the  older  Italian  universities  or  unfamiliar  with  the 
skill  and  learning  of  the  medical  men  of  the  Italy  of 
modern  times;  but  mankind,  when  the  herd  instinct  is 
strongly  developed,  exhibits  many  reactions  that  may 
be  traced  to  humble  ancestry  and  one,  at  least,  of  the 
meek  and  lowly  sheep,  namely :  that  of  crowding  through 
the  same  hole  in  the  fence  or  over  the  highest  barrier 
that  may  block  the  way.  And,  then  it  must  be  admitted 
that  the  art  and  architecture  of  Italy,  whether  pre- 
served or  in  ruins,  present  a  strong  appeal  to  persons  of 
education  and  artistic  taste. 

The  achievements  of  Italy  in  Medicine  and  Surgery 
during  the  last  war,  however,  have  been  so  great  that 
the  world  can  no  longer  fail  to  notice  them.  To  mention 
one — the  Surgery  of  the  Chest — until  Mikulicz  and 
Sauerbruch  undertook  its  study,  the  surgery  of  this 
region  had  not  changed  much  from  the  time  of  Hippoc- 


viii  FOREWORD 

rates.  During  the  war,  however,  French  surgeons 
boldly  invaded  the  pleural  cavity,  delivered  the  lung, 
it  it  was  injured  or  bleeding,  removed  foreign  bodies, 
replaced  the  lung  and  closed  the  cavity,  recognizing,  as 
did  Hippocrates  and  Pare,  the  dangers  of  an  open 
pleura  and  pleural  fistulse.  So  great  was  the  success 
achieved  by  this  method  that  one  celebrated  abdominal 
surgeon  is  reported  to  have  said  that  after  reviewing 
its  results  he  was  disposed  to  regard  as  wasted  the  time 
he  had  spent  on  studying  organs  below  the  diaphragm. 
So  strong  a  statement  is  obviously  the  hyperbole  of  a 
sudden  enthusiasm  and  not  justified  by  the  facts,  but 
there  can  be  no  doubt  that  in  Chest  Surgery  the  proce- 
dure referred  to,  represented  a  long  step  forward. 
Almost  at  once,  however,  a  much  longer  forward  step 
was  taken  by  an  Italian  surgeon,  Eugenio  Morelli,  who 
put  the  lung  at  rest  and  controlled  the  bleeding  by 
injecting  air  into  the  pleural  cavity,  a  maneuver  also 
suggested  by  an  Italian  doctor,  Carlo  Forlanini. 

It  is,  of  course,  impossible  to  name  here  any  con- 
siderable portion  of  the  medical  men  of  modern  Italy 
who  have  added  luster  to  their  science,  but  it  is  in  no 
sense  invidious  to  refer  to  Edoardo  Bassini  of  Padua 
and  his  original  operation  for  the  cure  of  inguinal 
hernia;  Francesco  Rizzoli  and  Alessandro  Codivilla  of 
Bologna  for  their  work  on  orthopedics;  Enrico  Bottini 
of  Pavia  for  his  contribution  to  the  surgery  of  the  pros- 
tate gland;  Edoardo  Porro  of  Milan  for  his  special 


FOREWORD  ix 

uterine  operation;  Antonio  Carle  of  Turin  and  G.  F. 
Novaro  of  Genoa  for  their  contributions  to  the  surgery 
of  the  intestines;  Francesco  Durante  of  Rome  for  his 
iodide  treatment  of  bone  tuberculosis;  Raffaele  Bas- 
tianelli,  also  of  Rome,  for  his  extensive  contribution 
to  the  surgery  of  the  thorax  and  abdomen;  Davide 
Giordano  for  his  study  of  the  surgery  of  the  kidneys; 
G.  Vanghetti  who  devised  experimentally  kineplastic 
flaps  for  amputations,  and  Antonio  Ceci  of  Pisa,  who, 
applying  these  principles  to  the  human  subject,  at- 
tained a  much  more  satisfactory  prosthesis  than  ever 
before  achieved. 

America  has  a  large  industrious  and  intelligent 
Italian  population;  New  York  City  alone  contains  a 
larger  Italian  city  than  any  to  be  found  within  the 
borders  of  the  Kingdom  of  Italy  itself.  For  economic, 
scientific  and  artistic  reasons  it  is  desirable  to  promote 
a  better  understanding  between  the  two  countries; 
particularly,  is  a  closer  affiliation  between  the  medical 
professions  of  the  two  countries  desirable.  Medicine 
has  always  borne  on  its  banners  an  inscription  to  the 
Brotherhood  of  Man  and  neither  maps  nor  languages 
should  interfere  with  its  progress. 

It  is  with  the  hope  of  promoting  and  fostering  such 
an  understanding  that  Dr.  Paolo  De  Vecchi,  an  eminent 
and  learned  Italian,  who  studied  at  the  University  of 
Turin,  and  has  spent  his  entire  professional  life  in 
America,  has  written  this  volume.  It  is  not  a  scientific 


x  FOREWORD 

review  by  any  means  but  a  brief  recital  of  what  has 
been  done  by  modern  surgeons  in  the  different  univer- 
sities of  Italy  in  the  last  fifty  years,  and  especially  during 
the  last  war.  To  the  surgeon  who  plans  to  visit  Italy, 
the  simple  and  clear  statements  contained  herein  will 
facilitate  his  introduction  to  the  institutions,  schools 
and  hospitals,  where  he  will  be  sure  to  find  that  pro- 
verbial courtesy  and  hospitality  which  characterizes 
his  Italian  colleagues. 

Honored  by  the  friendship  of  the  author  I  have  been 
privileged  to  read  his  book  in  manuscript,  and  I  take 
great  pleasure  in  recommending  it  to  the  friendly  con- 
sideration of  American  physicians. 

George  D.  Stewart. 

New  York, 
August,  1 92 1. 


PREFACE 

In  August,  1 914,  at  the  beginning  of  the  gigantic  war 
which  kept  the  entire  world  in  such  terrible  anxiety 
during  four  years  of  misery  and  devastation,  I  published 
a  booklet  under  the  modest  title  of  "Note  ed  osserva- 
zioni  sulla  Chirurgia  e  sui  Chirurgi  degli  Stati  Uniti 
dAmerica."  The  booklet  was  written  for  the  benefit  of 
the  young  Italian  fresh  from  a  medical  school  and  lacking 
post-graduate  surgical  training,  who  induced  by  dreams 
of  adventures  planned  to  emigrate  to  the  United 
States  with  the  mirage  of  a  professional  success  based 
only  upon  great  illusions  and  little  experience. 

That  brief  work,  quite  inadequate  to  the  subject,  was 
written  only  for  the  purpose  of  saving  some  young 
adventurous  colleagues  from  disastrous  failure,  due 
principally  to  their  complete  ignorance  of  the  real  stand- 
ing of  American  surgery,  and  of  the  enormous  progress 
made  by  American  surgeons  in  the  last  score  of  years. 

This  lack  of  knowledge  among  Italians,  with  few 
exceptions,  of  the  real  status  of  medicine  and  surgery 
in  the  United  States,  was  fully  reciprocated  by  a  similar 
ignorance  among  Americans  of  the  great  progress 
made  in  Italy  in  every  branch  of  the  scientific  field, 
especially  in  surgery,  during  the  last  fifty  years. 

The  reason  for  this  mutual  ignorance  was  obvious.  In 
Europe,  the  American  dollar  has  been  considered  the 
standard  of  the  progress  and  prosperity  of  America,  and 


xfi  PREFACE 

people  over  there  could  hardly  believe  that  an  American 
had  time  for  anything  but  the  accumulation  of  wealth. 

The  same  erroneous  idea  has  been  prevalent  among 
Americans,  who,  in  the  past,  have  travelled  in  Italy 
for  the  mere  solace  and  enjoyment  of  the  balmy  climate 
and  beautiful  scenery.  Only  a  few  scholars  have 
devoted  their  time  to  antiquities  and  to  art.  Perhaps  it 
might  be  said,  in  extenuation  of  the  above  assertion, 
that  some  of  these  scholars  have  also  devoted  their 
studies  to  modern  Italy;  but  their  attention  has  been 
generally  confined  to  the  political  and  social  phases  of 
the  new  nation. 

Italy's  great  struggle  for  the  achievement  of  her 
independence  absorbed  most  of  her  moral,  intellectual 
and  financial  resources  during  a  good  portion  of  the 
last  century,  and  the  Government,  pressed  by  urgent 
needs,  had  to  neglect  the  new  and  complex  educational 
system.  Nevertheless,  the  individual  efforts  of  her 
citizens,  who  deeply  felt  the  national  pride  and  the 
stimulus  of  race  tradition,  proudly  kept  the  sacred 
fire  of  scientific  study  alive,  until  the  storm  of  agitations, 
unavoidable  in  the  building  of  a  new  nation  divided 
for  centuries  under  foreign  rulers,  began  to  subside.  The 
return  of  peace  gave  to  the  collective  force  of  the 
country  a  chance  of  reviving  and  reorganizing  her 
scientific  studies;  again,  time  and  money  were  devoted 
to  the  national  universities  which  had  been,  for  other 
urgent  necessities,  somewhat  neglected. 

With  a  great  deal  of  pride,  the  young  nation  can 
now  look  upon  the  gratifying  result  of  her  efforts  in 
rebuilding,  from  the  chaos  of  antiquated  systems,  an 
almost  entirely  new  and  uniform  standard  of  schools 


PREFACE  xiii 

and  institutions,  equipped  with  modern  laboratories 
which  fully  meet  the  necessities  of  the  present  scientific 
requirements. 

When  we  consider  the  tremendous  financial  strain 
Italy  has  gone  through  during  seventy  years  of  strug- 
gles and  wars,  we  cannot  help  wondering  how  she 
could  accomplish  so  much.  At  the  same  time  we  cannot 
help  admiring  the  men  who  have  nobly  sacrificed  their 
time,  comfort,  and  wealth  for  the  love  of  their  country, 
and  for  the  advancement  of  science. 

A  brief  account  of  modern  Italian  surgery,  and  of 
the  men  who  have  distinguished  themselves  in  this 
field  is  presented  especially  for  the  purpose  of  bringing 
together  the  physicians  and  surgeons  of  Italy  and 
America.  This,  it  is  hoped,  will  bind  more  closely  in- 
ternational relations,  based  not  merely  on  a  mis- 
understood value  of  financial  power  on  the  one  side, 
and  past  history  on  the  other,  but  on  the  mutual  advan- 
tages resulting  from  the  exchange  of  ideas  and  of  studies, 
and  also  on  the  broad  conviction  that  science  is  not  a 
heritage  of  any  country  and  that  culture  cannot  be  a 
privileged  gift  of  any  one  individual  (much  less  an 
aristocratic  inheritance  of  any  particular  nation)  but 
is  and  will  always  be  the  democratic  patrimony  of  the 
whole  world. 

In  presenting  this  little  work  to  my  colleagues  in  the 
United  States,  I  feel  that  I  should  apologize  to  those 
in  my  native  country  for  a  book  which  is  absolutely 
inadequate  to  the  importance  of  the  subject.  My  only 
justification  is  my  purpose — that  of  trying  to  familiarize 
American  surgeons  with  the  Italian  school  of  surgery, 
in  the  hope  that  they  will  visit  Italy,  not  only  as  a 


xfv  PREFACE 

pleasure  resort,  or  a  center  of  antiquities,  but  as  a 
new  country  and  a  new  seat  of  education.  I  am  con- 
vinced that  the  knowledge  of  one  branch  of  medical 
research  may  bring  about  the  desire  for  further  study 
in  the  many  branches  of  modern  science,  in  which 
Italy  has  shown  herself  so  highly  proficient,  with  the 
inestimable  result  of  mutual  benefit  to  both  nations. 
I  could  not  deal  with  the  remarkable  progress  made 
by  Italian  surgeons  without  mentioning  the  Italian 
universities  with  which  the  school  of  surgery  is  always 
connected.  To  deal  with  such  a  vast  subject  as  the 
history  of  the  universities  of  Italy  would  mean  a  most 
extensive  work,  which  is  not  the  purpose  here.  How- 
ever, it  will  certainly  be  interesting  to  the  American 
reader  to  know  something  about  the  origin  and  the 
workings  of  such  institutions,  and  about  the  cities 
and  surroundings  which  may  attract  the  professional 
man  as  tourist,  combining  "utile  dulci,"  and  this 
account  may  induce  him  to  visit  the  universities  and 
familiarize  himself  with  the  surgical  school  of  each  one. 

P.  De  V. 

New  York, 
July,  192 1. 


CONTENTS 

Chaptbb  Paqh 

I.  Modern  Italy i 

II.  The  American  Red  Cross  in  Italy 12 

III.  The  Sanitary  Service  of  the  Italian  Army  Dur- 
ing the  War 26 

IV.  A  School  of  Medicine  and  Surgery  in  the  War  34 

V.  Medical  Organization  and  Efficiency  During 

the  War 37 

VI.  Assistance    to    Invalids    and    the    Work    of 

Reconstruction 44 

VII.  The  Care  of  Cripples  and  Orthopedic  Surgery 

in  Italy 74 

VIII.  Modern  Surgery  in  Italy 92 

IX.  Practical  Surgery 97 

X.  Universities  in  Italy 101 

XI.  The  University  of  Rome no 

XII.  The  University  of  Bologna 122 

XIII.  Universities  of  Modena  and  Parma 132 

XIV.  The  University  of  Padua 138 

XV.  The  University  of  Pavia 144 

XVI.  Scientific  Institutes  of  Learning  in  Milan.   .    .  154 

XVII.  The  University  of  Turin 163 

XVIII.  The  University  of  Genoa 170 

XIX.  The  University  of  Pisa 178 

XV 


xvi  CONTENTS 

Chapter  Pagb 

XX.  The  University  of  Siena.   .   . 182 

XXI.  The  Institutes  of  Florence 188 

XXII.  The  University  of  Naples 192 

XXIII.  The  Universities  of  Sicily 199 

XXIV.  The  Universities  of  Sardinia 210 

XXV.  Free  Universities 213 

XXVI.  Surgical  Literature 215 

Index 239 


LIST  OF  ILLUSTRATIONS 

Handicraft  School  for  War  Cripples  at  Milan.  . . .  facing  p.    46 

Prof.  Alessandro  Codivilla,  Bologna facing  p.    74 

Orthopedic  Clinic  at  Milan facing  p.    80 

Panoramic  View  of  the  Rizzoli  Orthopedic  Insti- 
tute at  Bologna facing  p.    82 

Prof.  Vittorio  Putti,  Bologna facing  p.    86 

Doorway  of  Rizzoli's  Orthopedic  Institute;  Vic- 
tor Emanuel  III  standing  beside  Prof.  Vittorio 
Putti facing  p.    84 

Dr.  Guido  Baccelli,  Rome facing  p.  1 16 

Bird's-eye  View  of  the  Polyclinic  Institute,  Rome,  facing  p.  118 

Main    Entrance  of  the   Polyclinic    Institute   at 

Rome facing  p.  120 

Prof.  RafFaele  Bastianelli,  Rome facing  p.  122 

Bologna,  from  the  Rizzoli  Orthopedic  Institute. . .  facing  p.  128 

Prof.  Edoardo  Bassini,  Padua facing  p.  142 

Clinic  for  Occupational  Diseases  at  Milan facing  p.  158 

Hospital  for  Contagious  Diseases  at  Milan facing  p.  160 

Prof.  G.  F.  Novaro,  Genoa facing  p.  174 


XVU 


xvi  CONTENTS 

Chapter  Pagb 

XX.  The  University  of  Siena.   .   . 182 

XXI.  The  Institutes  of  Florence 188 

XXII.  The  University  of  Naples 192 

XXIII.  The  Universities  of  Sicily 199 

XXIV.  The  Universities  of  Sardinia 210 

XXV.  Free  Universities 213 

XXVI.  Surgical  Literature 215 

Index 239 


LIST  OF  ILLUSTRATIONS 

Handicraft  School  for  War  Cripples  at  Milan.  . . .  facing  p.    46 

Prof.  Alessandro  Codivilla,  Bologna facing  p.    74 

Orthopedic  Clinic  at  Milan facing  p.    80 

Panoramic  View  of  the  Rizzoli  Orthopedic  Insti- 
tute at  Bologna facing  p.    82 

Prof.  Vittorio  Putti,  Bologna facing  p.    86 

Doorway  of  Rizzoli's  Orthopedic  Institute;  Vic- 
tor Emanuel  in  standing  beside  Prof.  Vittorio 
Putti facing  p.    84 

Dr.  Guido  Baccelli,  Rome facing  p.  116 

Bird's-eye  View  of  the  Polyclinic  Institute,  Rome,  facing  p.  118 

Main    Entrance  of  the   Polyclinic    Institute  at 

Rome facing  p.  120 

Prof.  RafTaele  Bastianelli,  Rome facing  p.  122 

Bologna,  from  the  Rizzoli  Orthopedic  Institute. . .  facing  p.  128 

Prof.  Edoardo  Bassini,  Padua facing  p.  142 

Clinic  for  Occupational  Diseases  at  Milan facing  p.  158 

Hospital  for  Contagious  Diseases  at  Milan facing  p.  160 

Prof.  G.  F.  Novaro,  Genoa facing  p.  174 


Chapter  I 
MODERN  ITALY 

WE  all  know  something  of  Italy,  her  ancient 
history,  her  connection  with  the  Roman 
Empire,  and  perhaps  most  of  us  know, 
from  school,  her  geographical  location, 
while  some  of  us  are  familiar  with  the  principal  haunts, 
which  for  years  have  been  the  joy  of  tourists,  artists 
and  poets  looking  for  pleasure  and  inspiration. 

But  few  of  us  know  the  history  of  modern  Italy,  of 
this  new  nation,  only  a  little  over  half  a  century  old, 
born  from  the  chaos  of  the  Middle  Ages,  and  freed  from 
the  dismemberment  and  oppression  of  many  foreign 
usurpers  after  a  long  struggle  amid  almost  insuperable 
difficulties. 

No  true  and  impartial  history  of  this  young  nation  has 
yet  been  written,  the  warm  partisan  feeling  of  most  of 
the  men  who  took  part  in  the  building  of  the  new 
country  being  responsible  for  this. 

The  fall  of  the  Roman  Empire  left  Italy  exposed 
for  centuries  to  the  invasions,  depredations  and  devas- 
tations of  the  barbarians  of  the  east,  of  the  north,  of 
the  south,  and  from  over  the  sea.  Goths,  Ostrogoths, 
Vandals,  Huns  and  Saracens,  attracted  by  the  beauty 
and  the  wealth  of  the  country,  pillaged  everything 
which  could  be  useful  to  them,  destroying  the  rest  for 
the  inborn  lust  of  destruction. 


2  MODERN  ITALIAN  SURGERY 

Later  on,  Italy  became  a  coveted  prey  of  the  French 
or  German  rulers,  who,  for  centuries,  disputed  the 
possession  of  her  fertile  land,  which  was  often  the  field 
of  terrible  battles,  until  sparks  of  national  pride  gave 
origin  to  the  Lombard  Communes,  the  republics  of 
Venice,  of  Genoa,  of  Pisa,  of  Florence;  the  duchies  of 
Milan,  of  Savoy;  the  small  kingdoms  of  Naples-Sicily,  of 
Sardinia,  and  later  the  duchy  of  Tuscany — all  striving 
in  a  continual  fight  and  dispute  for  local  or  seminational 
supremacy. 

To  Dante  Alighieri,  the  great  national  poet  of  Italy, 
belongs  the  glory  of  being  the  first  exponent  of  a 
national  unity,  and  his  ideas  for  centuries  were  the 
dream  of  most  of  the  intellectual  people  of  the  country, 
until  the  sparks  of  the  French  Revolution,  which  spread 
all  over  Europe,  were  conveyed  to  Italy  by  Napoleon, 
the  ambitious  Corsican,  who  planned,  in  his  restless 
mind,  a  crown  for  his  family. 

The  fall  of  Napoleon  did  not  extinguish  the  sacred 
fire  of  liberty.  The  idea  already  inflamed  the  minds 
of  the  best  intellects  of  the  country,  who  had  already 
worked  together  in  harmony  for  one  purpose,  "To  free 
their  people  from  foreign  dominations."  It  was  that 
patriotic  understanding  among  the  most  intellectual 
men  throughout  Italy,  elated  by  the  writings  of  Carlo 
Cattaneo,  Giuseppe  Mazzini,  Vincenzo  Gioberti,  Rug- 
giero  Settimo,  and  hundreds  of  others,  which  established 
the  sentiment  of  unification  among  the  masses,  against 
the  rabid  rulers,  who  were  trying  to  retain  possession 
of  their  trembling  crowns. 

During  the  last  century  the  Italians,  north,  south, 
east  and  west,  fought  hard  for  their  freedom   from 


MODERN  ITALY  3 

foreign  tyranny  and  domination  against  which  they 
had  risen  on  several  occasions  unsuccessfully. 

The  Neapolitan  provinces  and  the  island  of  Sicily 
were  under  the  rule  of  the  Bourbons,  which  Gladstone 
had  called  "The  Negation  of  God."  The  Central  States 
were  under  the  spiritual  and  temporal  power  of  the 
Pope.  Venice  with  Lombardy,  the  northeastern  part  of 
Italy,  was  under  the  heel  of  the  Austrian  reigning  house 
of  Hapsburg,  whose  relatives  were  holding  the  duchies 
of  Tuscany,  Parma,  Piacenza  and  Lucca. 

The  house  of  Savoy  ruled  over  Piedmont,  the  little 
kingdom  in  the  northwest  of  Italy,  which  soon  became 
the  asylum  of  all  the  political  refugees.  In  Turin,  the 
capital  of  the  little  kingdom,  these  refugees,  exiled 
from  the  oppressed  provinces,  found  sympathy,  en- 
couragement and  shelter;  together  they  worked  and 
conspired  for  the  liberation  of  their  country  from 
tyrannical  servitude  and  for  a  future  united  Italy,  the 
common  mutual  aspiration  of  the  majority  of  the 
inhabitants  of  the  country. 

The  liberal  constitution,  framed  and  given  to  the 
people  of  Piedmont  by  its  king,  Carlo  Alberto,  in  the 
year  1 848,  bound  together  all  the  liberal  leaders  of  the 
rest  of  Italy.  They  rushed  to  the  colors  under  one  flag 
of  three  symbolic  colors — green,  white  and  red — which 
ever  since  has  been  the  flag  of  New  Italy.  From  that 
year  started  the  gigantic  fight  between  the  little  king- 
dom of  Piedmont  and  the  mighty,  powerful  double 
empire  of  Austria-Hungary,  the  David  and  Goliath 
struggle  of  modern  times. 

It  would  be  too  long  here  to  recount  the  many  epical 
deeds  of  the  new  nation,  the  audacious  insurrection  of 


4  MODERN  ITALIAN  SURGERY 

Milan,  the  short-lived  republic  of  Rome  and  its 
dramatic  defence  against  the  French  Army,  the  Revo- 
lutions of  Naples,  of  Palermo,  the  long  and  glorious 
defence  of  Venice,  and  the  campaign  of  Lombardy 
which  ended  disastrously  at  the  battle  of  Novara. 
The  die  was  cast,  and  the  destiny  of  Italy  was  in  the 
hands  of  her  valiant  men,  determined  to  win  or  die. 

The  participation  of  Piedmont,  as  an  ally  of  England 
and  France  in  the  Crimean  campaign  against  Russia, 
was  a  skillful  diplomatic  triumph  of  Camillo  Benso  di 
Cavour,  the  great  Italian  premier,  who  won,  then, 
the  moral  support  of  England  and  the  material  help  of 
France  in  the  following  campaign  of  1859  against 
Austria.  The  campaign  ended  with  the  victory  of 
Solferino  and  San  Martino  and  the  liberation  of 
Lombardy. 

The  following  year  a  daring  expedition  led  by 
Giuseppe  Garibaldi  with  one  thousand  volunteers 
landed  in  Sicily,  starting  a  revolution  which  rapidly 
spread  through  the  kingdom  of  Naples,  and,  after 
several  brilliant  combats,  ended  at  the  battle  of 
Volturno  the  domination  of  the  Bourbons,  annexing 
the  Neapolitan  and  Sicilian  provinces  to  the  new 
kingdom  of  Italy. 

But  the  unification  of  Italy  was  rapidly  approaching 
realization.  Only  a  few  years  after,  in  1866,  the  war 
between  Prussia  and  Austria,  which  ended  so  dis- 
astrously for  the  double  empire  at  the  battle  of  Sa- 
dowa,  gave  Italy  the  opportunity  of  attacking  Austria 
and  of  winning  the  Venetian  provinces.  Again,  a  few 
years  later,  the  fall  of  Napoleon  [ in,  at  the  battle 
of  Sedan,  deprived  the  Vatican  of  a  military  support 


MODERN  ITALY  5 

for  the  temporal  power,  and  soon  after  (September  20, 
1870)  the  Italian  troops  occupied  Rome,  which,  by 
a  popular  vote,  was  declared  the  capital  of  Italy. 

To  complete  the  dream  of  Dante,  the  much  coveted 
aspiration  of  the  Italian  people,  there  remained  only 
two  provinces,  Trent  and  Trieste,  which  were  yet  under 
the  yoke  of  Austria-Hungary. 

Notwithstanding  the  intense  unanimous  desire  of 
the  Italians  for  the  possession  of  those  two  provinces, 
not  only  for  sentimental  reasons  but  for  political, 
strategical  and  commercial  purposes,  the  difficulty  of 
the  enterprise,  from  a  military  and  naval  point  of  view, 
was  so  great  that  the  majority  of  the  people  hesitated, 
when,  here  again,  the  good  star  of  Italy  came  to  her 
help. 

A  little  digression  is  necessary  to  understand  the 
exact  political  situation  of  Italy  at  the  time  the  war 
started  in  1914. 

Since  her  defeat  of  1870-71,  the  unwise  policy  of 
France,  jealous  of  Italy's  rapid  aggrandizement  as  a 
commercial  rival,  brought  the  country  unwillingly  into 
an  alliance  with  Germany  and  Austria-Hungary,  which, 
notwithstanding  its  simply  defensive  character,  yet 
was  looked  upon  with  unpopular  feeling  throughout  the 
peninsula  because  of  the  natural  antipathy  and  dislike 
of  a  German  commercial  invasion. 

When  Austria  declared  war  upon  Serbia,  Italy,  in 
consequence  of  her  antipathy,  at  once  joyfully  took  the 
opportunity  of  severing  her  pact  of  defensive  alliance 
with  Germany  and  Austria-Hungary.  Italy  was  at  that 
time  financially  somewhat  depleted  because  of  the  two 
years  of  war  in  Libya;  yet  the  old  spirit  of  the  nation 


6  MODERN  ITALIAN  SURGERY 

met  the  situation  with  courage  and  determination, 
denouncing  freely  the  Austro-Hungarian  attack  on 
Serbia  as  an  arrogant,  unjustifiable  act  of  abuse  of 
force. 

France  was  at  once  notified  of  Italy's  determination 
to  keep  absolutely  neutral,  assuring  her  that  she  had 
nothing  to  fear  along  her  borders,  thus  giving  her  the 
chance  of  withdrawing  half  a  million  of  troops  just  in 
time  to  press  them  on  the  Marne,  to  save  Paris  from 
capture. 

Never  had  the  Italian  Government  been  in  such  a 
critical  condition  before,  with  most  of  the  army  still 
engaged  in  the  desert  of  Africa.  Those  were  anxious 
moments  for  all;  moments  of  incertitude  and  hesitation 
which  gave  to  the  conservative  party  a  grave  responsi- 
bility. A  shrewd  German  diplomat,  von  Buelow,  tried 
to  take  advantage  of  the  delay  for  the  purpose  of 
gaining  time,  which  was  very  precious  for  the  Austro- 
Hungarian  army,  then  engaged  on  the  Russian  front. 

But  the  young  national  party  succeeded  in  stirring  up 
the  popular  feeling,  and  enthusiasm  had  no  bounds 
when  the  well-known  poet  and  dramatist,  Gabriele 
D'Annunzio,  in  an  inspired  speech  delivered  from  the 
Rock  of  Quarto,  while  celebrating  the  anniversary 
of  the  expedition  of  Garibaldi  to  Sicily,  denounced 
the  hesitation  of  the  Government  as  treachery  and 
cowardice,  and  called  upon  the  people  of  Italy  to  fight 
for  the  honor,  for  the  liberty  of  the  mother  country,  for 
the  civilization  and  humanity  of  the  world. 

The  conservative  party  resigned,  pressed  by  the 
excited  crowd  clamoring  for  war,  and  the  King  had  to 
summon  a  set  of  more  aggressive  men  who  would 
assume   the   responsibility   of  carrying   through   the 


MODERN  ITALY  7 

wishes  of  the  people,  unmindful  of  the  tremendous  task 
of  raising  the  great  amount  of  money  needed  for  a 
large,  strong  army,  well  equipped  and  properly  fitted 
for  the  gigantic  task  of  attacking  a  powerful  army 
entrenched  in  fortifications  built  after  fifty  years  of 
skillful  and  patient  work,  upon  mountains  considered 
impregnable  by  the  best  experts  in  military  affairs. 

But,  following  the  day  of  the  declaration  of  war, 
everyone,  from  the  King  to  the  last  citizen,  understood 
that  it  was  a  fight  to  a  finish,  a  fight  for  life  or  death,  and 
everyone  gave  generously  everything  for  the  accom- 
plishment of  the  great  purpose. 

The  hardships  which  Italy  suffered  during  the  three 
years  of  the  terrible  war  are  only  known  to  those  who 
travelled  through  the  country  and  visited  the  front 
during  that  time.  It  was  beyond  description;  but  it  has 
proved  to  the  world  that  the  Italians  are  a  united 
nation,  not  only  as  a  race,  but  in  character,  in  sentiment, 
in  thought  and  in  purpose.  They  went  into  that  war 
with  the  firm  purpose  and  conscience  of  fighting  for 
their  sacred  rights,  of  making  their  country  free  from 
foreign  domination  and  oppression,  free  from  future 
danger  of  aggression  and  abuses. 

It  was  a  formidable  undertaking  and  a  gigantic  work 
for  a  new  army,  continually  exposed  to  hardships  which 
were  unknown  at  the  other  fronts,  fighting  against  moun- 
tains above  the  clouds,  at  10,000  feet  above  the 
sea  level,  entrenched  in  perpetual  snow  and  ice,  threat- 
ened by  deadly  avalanches  that  entombed  many 
victims,  buried  in  those  crevasses  from  which  even  the 
bodies  could  not  be  rescued.  Thousands,  victims  of 
frost-bite  requiring  amputations,  were  lost  to  the  force, 


8  MODERN  ITALIAN  SURGERY 

and  a  great  many,  exposed  to  the  inclemency  of  the 
weather  and  the  suffering  of  the  trenches,  lost  their 
health  forever.  But  the  majority  of  the  "AIpini"  (a  se- 
lect army  corps),  hardened  by  the  strenuous  life,  elated 
by  the  mirage  of  the  final  success  of  the  Italian  cause, 
kept  the  enemy  at  bay,  surprising  him  with  a  tremen- 
dous activity,  building  magnificient  roads — marvels  of 
engineering — overcoming  the  difficulty  of  carrying 
provisions  and  supplies  over  the  mountains  by  erecting 
aerial  railways  on  which  to  bring  guns,  ammunitions, 
food,  water,  and  returning  the  wounded  soldiers  to  be 
cared  for  in  the  hospitals. 

The  famous  quick-stepping  "Bersaglieri"  helped  the 
AIpini  in  their  counter-attacks,  and  another  selected 
body  of  troops,  the  "Arditi,"  rushed  to  death  by 
advancing  to  cut  the  wire  fences  and  clear  the  way  for 
the  advancing  troops. 

The  work  of  the  engineering  corps  was  marvellous 
throughout  the  entire  campaign,  building  stupendous 
roads,  tunnelling  mountains,  throwing  bridges  over  the 
Isonzo  River;  under  tremendous  artillery  fire  from  the 
enemy,  setting  up  barracks  and  hospitals  which  were 
models  of  shelter  under  such  arduous  conditions. 

The  disaster  of  Caporetto,  which  at  first  was  consid- 
ered fatal  because  an  entire  army  corps  had  been 
surprised  and  compelled  to  surrender  or  disperse, 
proved  instead  an  incentive  to  a  patriotic  revival 
throughout  all  Italy.  The  entire  population  realized  the 
danger  of  a  propaganda  which  had  been  working  among 
the  soldiers  in  the  trenches  and  among  the  families 
at  home,  depressing  the  spirit  of  the  poor  people  after 
their  long  suffering. 


MODERN  ITALY  9 

It  was  the  inspired,  popular  resistance  of  the  brave 
soldiers  that  nerved  them  unanimously  to  select  the 
Piave  River  as  the  line  where  they  could  make  the 
stubborn  and  deadly  stand  which  they  did.  One  year  of 
anxiety,  amid  the  hurried  preparations  for  an  attack, 
ended  with  the  most  brilliant  victory  of  the  campaign 
after  seven  days  of  one  of  the  bloodiest  battles  in  the 
history  of  war. 

On  November  3,  the  Austro-Hungarian  army, 
completely  defeated  at  Vittorio,  demanded  an  armis- 
tice, surrendering  without  conditions.  One  million 
prisoners,  8,000  cannons,  250,000  horses  fell  into  the 
hands  of  the  victorious  army  of  Italy,  beside  the 
enormous  provisions  which  the  enemy  had  no  time  to 
destroy. 

The  fall  of  the  Austro-Hungarian  Empire,  a  surprise 
to  the  world,  hastened  the  collapse,  on  the  Western 
Front,  of  the  German  army,  which,  only  eight  days 
after,  begged  for  an  unconditional  armistice. 

Italy's  great  victory  at  the  battle  of  Vittorio- Veneto, 
on  the  River  Piave,  placed  her  among  the  great  nations 
of  Europe.  Accordingly  she  was  called  to  take  her 
place  as  the  fourth  great  nation  to  discuss  peace  terms 
and  international  interests  for  a  possible  future  peace. 

The  war  had  cost  her  500,000  soldiers  killed,  300,000 
dead  of  diseases  contracted  in  war,  800,000  wounded, 
400,000  crippled  for  life,  and  twelve  billions  of  dollars 
of  national  debt,  which  amounts  to  almost  two-thirds 
of  her  entire  national  wealth. 

But  Italy  has  the  enormous  reserve  of  human  labor; 
80  per  cent  of  her  people  are  laborers,  sober,  persistent, 
skillful  and,  above  all,  economical.  With  that  capital 


io  MODERN  ITALIAN  SURGERY 

at  hand  she  will  face,  serene,  the  hardships  of  her 
financial  obligations,  especially  now  that  her  troubles 
are  over. 

The  struggle  of  seventy  years  of  agitations  and  wars, 
the  necessity  of  looking  for  help,  the  unfortunate 
alliance  she  was  compelled  to  accept,  have  taught  her 
people  to  trust  only  in  themselves,  to  rely  on  their  own 
capacities,  to  depend  principally  on  their  national  unity, 
which  means  strength,  power,  ability  in  developing 
their  own  resources  to  the  full  capacity. 

Recent  events  have  shown  how  much  Italy  has  appre- 
ciated the  noble  help  that  America  has  given  her  in 
her  moments  of  distress  and  intense  suffering,  and  the 
people  of  Italy  will  never  forget  what  America  has 
done  for  humanity,  for  civilization,  for  that  liberty 
which  is  so  dear  to  Americans,  and  for  which  they 
sacrificed  so  much  in  this  last  struggle  for  international 
independence. 

Modern  Italy  is  a  democratic  nation,  whose  King 
has  been  described  by  Theodore  Roosevelt,  in  his 
letter  to  George  Trevelyan,  as  the  most  liberal  ruler  he 
met  in  his  trip  through  Europe  in  191 1. 

Victor  Emanuel  m  has  been  the  faithful  guardian  of 
the  constitution  framed  by  the  patriots  of  1848,  and 
sworn  to  by  his  great  grandfather  Carlo  Alberto,  king 
of  Piedmont  and  Sardinia,  the  little  state  which,  headed 
by  the  house  of  Savoy,  started  the  redemption  and 
unification  of  Italy. 

The  name  of  Mazzini,  the  name  of  Cavour,  the  name 
of  Garibaldi  cannot  be  separated  from  that  of  Victor 
Emanuel  11,  the  grandfather  of  the  present  king.  The 
history  of  modern  Italy  cannot  be  written  without  men- 


MODERN  ITALY  u 

tion  of  all  these  factors  of  her  independence,  of  her  libera- 
tion, without  praise  of  that  great  army  which  brought 
gloriously  to  a  close  the  great  drama  of  her  final  unifica- 
tion, and  at  the  head  of  which  stood  calm,  serene, 
confident,  in  the  midst  of  the  great  storm,  the  noble 
figure  of  Victor  Emanuel  in. 


Chapter  II 
THE  AMERICAN  RED  CROSS  IN  ITALY 

WHAT  the  American  Red  Cross  has  done  to 
alleviate  the  horrors  of  the  war  can  hardly 
be  written;  it  is  beyond  description.  But 
the  gratitude  of  the  world  will  remain  as  a 
testimonial  to  the  great,  generous  and  incomparable 
work  which  was  carried  on,  on  every  field,  with 
undaunted  sacrifice  by  men  and  women  devoted  to  the 
noblest  cause  of  humanity. 

Among  the  numerous  commissions  sent  over  by  the 
Red  Cross  from  Washington,  one  left  for  Italy,  July 
28,  191 7,  to  investigate  and  study  the  needs  of  that 
country.  Two  distinguished  medical  men  accompanied 
that  commission,  Dr.  Thomas  W.  Huntington,  emeritus 
professor  of  surgery,  University  of  California,  and  Dr. 
Victor  G.  Heiser  of  the  Rockefeller  Foundation,  who 
had  been  professor  of  hygiene,  Philippine  University. 
Both,  with  friendly  courtesy,  authorized  me  to  insert 
in  this  work  an  account  of  their  experience,  which  is 
rather  flattering  for  the  Army  Medical  Organization  in 

Italy. 

San  Francisco,  Calif., 
August  23,  19 1 8. 

My  Dear  Dr.  De  Vecchi: 

In  response  to  your  request,  permit  me  to  contribute  this  note 
which  I  place  at  your  disposal. 


THE  AMERICAN  RED  CROSS  IN  ITALY  13 

With  the  American  Red  Cross  Commission  to  Italy,  we  crossed 
the  line  between  France  and  Italy  early  in  September,  191 7. 

There  was  assigned  to  me  the  very  pleasant  task  of  inspecting 
hospitals  of  all  types  of  the  Italian  army,  and  the  Italian  Red 
Cross,  and  a  large  number  of  wounded  who  were  being  cared  for  in 
said  institutions. 

From  the  moment  of  our  advent  upon  Italian  soil  we  were  deeply 
impressed  by  the  devotion,  the  efficiency  and  the  brilliant  achieve- 
ment of  Italian  surgeons. 

Fairly  familiar  with  the  literature  of  Continental  Europe  and 
England,  I  frankly  confess  that  my  knowledge  of  Italian  surgery 
and  surgeons  was  deplorably  deficient.  As  we  progressed  through 
Genoa,  Rome,  throughout  the  northern  front  on  the  Isonzo  River, 
through  Milan,  Florence,  Venice  and  in  southern  Italy  to  Palermo, 
a  revelation  was  awaiting  us  at  every  point.  The  number  of 
wounded  was  appalling. 

The  tragedies  of  civil  life  have  ever  been  individual,  in  the 
singular  or  by  the  score.  The  tragic  incidents  of  warfare  as  seen  in 
the  military  hospitals  are  by  the  hundreds,  thousands,  and  ten 
thousands. 

Hospital  organizations  everywhere  showed  a  development  and  a 
completeness  that  will  form  an  interesting  chapter  in  the  history 
of  the  present  war.  Chiefs  of  departments  were  chosen  wisely  from 
a  coterie  of  surgeons,  alert,  brilliant,  highly  trained,  and  in  every 
sense  masters  in  their  profession.  To  me  it  was  delightful  to  note 
the  absolute  forgetfulness  of  self  as  shown  by  men  high  in  rank, 
whose  duties  were  manifold.  Not  infrequently  men  of  this  type  were 
found  diligently  at  work  in  their  several  stations  from  early 
morning  till  late  at  night.  During  the  active  periods  when  the 
ingress  of  wounded  was  overwhelming,  chiefs  and  their  staffs  not 
infrequently  remained  on  duty  twenty-four,  thirty-six,  and  forty- 
eight  hours,  with  brief  intervals  of  rest.  The  reflex  of  this  spirit 
was  shown  in  the  status  of  the  wounded,  and  in  the  discipline  of  the 
junior  officers. 

The  problem  of  sepsis  and  of  ordinary  and  special  infection  were 
met  by  a  clearness  of  perception  and  full  appreciation  of  scientific 
development. 


14  MODERN  ITALIAN  SURGERY 

At  Milan  it  was  my  good  fortune  to  spend  an  hour  in  conference 
with  Professor  Tizzoni  of  Bologna,  who  is  one  of  the  world  authori- 
ties in  the  investigation  and  treatment  of  tetanus.  Professor  Tizzoni 
was  one  of  the  first,  if  not  the  first,  to  administer  dosages  of  anti- 
tetanus serum.  This  he  had  worked  out  in  his  own  laboratory,  and 
has  given  to  the  Italian  army  the  great  benefit  of  his  research. 

Nowhere  is  the  artistic  spirit  of  the  Italian  shown  more  forcefully 
than  in  the  plastic  work  which  is  being  done  in  the  Italian  hospitals 
in  the  interest  of  face  and  jaw  wound.  Long  series  of  ghastly 
mutilations  of  this  type  were  shown  us  in  the  ward  and  by  photo- 
graph in  many  hospitals  where  this  class  of  work  has  been  highly 
specialized.  It  is  interesting  to  note  that  several  of  the  most  brilliant 
and  artistic  operators  in  this  field  were  educated  in  American  dental 
schools.1  This  manifestly  was  supplemented  by  the  inspiration  of 
Italian  art. 

The  treatment  of  wounds  by  the  Carrel-Dakin  method  has  been 
developed  splendidly  in  nearly  all  the  hospitals  in  Italy.  Where- 
ever  the  apparatus  for  this  procedure  was  available,  it  was  in 
use.  In  one  hospital  unit  I  found  2,100  cases  of  open  fractures, 
all,  or  nearly  all,  treated  by  the  Carrel  method.  The  tempera- 
ture chart  reflected  in  a  graphic  way  the  result  of  the  surgeon's 
efforts.  The  old  see-saw  chart,  denoting  protracted  and  deep  in- 
fection, was  not  to  be  found  in  the  entire  establishment. 

The  casualty  dressing  stations  were  uniformly  located  in  or 
contiguous  to  the  first  line  trenches.  Evacuation  or  Field  Hospitals 
were  placed  as  near  as  safety  permitted  to  the  casualty  dressing 
stations,  thereby  insuring  prompt  relief  to  the  gravely  wounded. 

Looking  back  upon  my  experience  and  observation  in  the 
hospitals  of  this  splendid  country,  I  find  little  to  suggest  as  a  re- 
vision and  much  to  elicit  admiration  and  commendation. 

Very  truly  yours, 

Thomas  W.  Huntington, 

Late  member  of  the  American  Red  Cross  Commission  in  Italy. 

*Dr.  Albert  Webb,  a  successful  American  dental  surgeon  practising  in 
Rome,  distinguished  himself  at  the  front  as  a  captain  in  the  Italian  Sanitary 
Corps. 


THE  AMERICAN  RED  CROSS  IN  ITALY  i5 

In  addition  to  the  illuminating  letter  of  Dr.  Thomas 
W.  Huntington,  the  lecture  read  before  the  College  of 
Physicians  of  Philadelphia,  January  2,  191 8,  by  Dr. 
Victor  G.  Heiser  of  the  Rockefeller  Foundation  has 
points  which  should  command  the  closest  attention  on 
the  part  of  the  reader. 

Some  of  the  Accomplishments  of  Italian  Medical  Men 
in  the  War1 

Victor  G.  Heiser,  M.  D. 

Member,  American  Red  Cross  Commission  in  Italy 

It  is  generally  understood  that  the  Italian  army  at  the  present 
time  consists  of  at  least  4,000,000  men,  and  that  the  number  of 
hospital  beds  is  approximately  1,000,000. 

Just  what  it  means  in  two  years  to  expand  a  country's  hospi- 
tal service  to  these  huge  proportions  can  be  better  appreciated 
when  it  is  recalled  that  in  the  entire  United  States,  with  a  popula- 
tion almost  three  times  as  great  as  that  of  Italy,  there  are  only 
300,000  beds.  Yet  in  spite  of  this  vast  achievement,  the  work  ac- 
complished by  the  Italian  medical  profession  since  the  beginning 
of  the  war  has  attracted  to  itself  but  little  attention  in  this  country. 
The  reason  for  this  is  obvious.  While  probably  none  of  the 
Allies  who  are  fighting  in  Europe  has  received  less  aid  other  than 
financial  help  from  outside  their  own  borders,  the  medical  men  of 
Italy  almost  invariably  were  loath  to  speak  of  their  achievements. 
There  was  no  boasting  anywhere. 

It  is  characteristic  of  the  Italian  Medical  Service  to  achieve  re- 
sults and  then,  perhaps,  talk  about  them.  Nowhere  did  we  hear  of 
what  the  medical  service  was  going  to  do.  It  was  only  the  thing 
they  had  done  of  which  they  could  be  induced  to  speak. 

The  equipment  necessary  for  preventing  disease  and  for  the  care 
of  the  sick  and  wounded  has  been  provided  almost  entirely  in 
Italy.  In  many  instances  establishments  for  the  production  of 
hospital  and  medical  supplies  did  not  exist  at  the  outbreak  of  the 
war,  and  had  to  be  created.  Large  institutions  for  the  re-education 
of  the  injured,  which  will  compare  favorably  with  the  best,  are 
1  J.  Am.  M.  Ass.,  Jan.  5,  1918,  Ixx,  24-27. 


16  MODERN  ITALIAN  SURGERY 

in  full  operation.  Hospitals  rendering  excellent  service  exist  near 
the  front-line  trenches.  New  types  of  hospital  construction  have 
been  evolved.  Mobile  hospitals  of  ioo-bed  capacity,  which  can  be 
taken  down  and  transferred  75  miles  and  set  up  and  put  in  service 
again  within  twenty-four  hours,  are  in  use;  the  entire  equipment, 
including  the  hospital  furniture,  instruments,  operating  room 
appliances,  and  roentgen-ray  plant,  is  transported  on  five  camions 
(motor  trucks)  and  three  touring  cars.  New  operations,  particu- 
larly in  dental  surgery  and  lung  surgery,  new  instruments  and 
devices  without  number,  have  been  developed.  The  following 
statement,  although  very  incomplete,  may  convey  some  idea  of 
what  had  been  accomplished  by  the  Italian  medical  profession  up  to 
October  1,  191 7. 

ORGANIZATION 

The  Italian  Medical  Service  is  presided  over  by  an  official  who 
has  his  office  with  the  Minister  of  War  at  Rome.  The  service, 
however,  is  not  so  highly  centralized  as  is  the  case  in  this  country. 
There  is  a  chief  medical  officer,  common  to  all  the  armies,  who  has 
his  headquarters  near  the  front,  at  a  point  which  is  the  principal 
center  for  the  storage  and  distribution  of  supplies,  not  only  for 
the  medical  department,  but  also  for  the  entire  army. 

Representatives  of  the  Quartermaster's  and  Commissary  De- 
partments of  the  Signal  Corps,  Ammunition  Department,  Red 
Cross,  and  other  branches  of  the  army  are  located  there.  They 
dine  together  in  a  common  mess  hall  and  have  ample  opportunities 
for  cooperation.  Under  the  chief  medical  officer,  there  is  stationed 
with  each  army  a  principal  medical  officer  who  has  almost  deter- 
mining powers  in  directing  medical  work  pertaining  to  the  army 
with  which  he  is  stationed. 

The  care  of  the  wounded  at  the  front,  as  well  as  throughout 
Italy,  is  undertaken  jointly  by  the  Italian  Red  Cross  and  "Sanita- 
Militare"  or  army  medical  service,  medical  aid  being  rendered 
through  the  following  seven  classes  of  agencies,  which  cooperate 
in  passing  back  the  wounded  with  a  remarkable  degree  of  efficiency, 
and  may  be  considered  in  the  order  of  their  relative  distance  from 
the  front  line  trenches. 


THE  AMERICAN  RED  CROSS  IN  ITALY  17 

1.  The  "Posti  di  Medicazione."  These  are  the  most  advanced 
dressing  stations  for  emergency  services,  and  are  located  usually 
in  dug-outs  in  trenches  very  close  to  the  front. 

2.  The  "Sezione  Sanita."  From  1  to  2  kilometers  behind  the 
front,  usually  at  a  point  which  can  be  reached  by  an  ambulance, 
are  the  "Sezioni  di  Sanita"  or  dispensaries.  They  are  more  fully 
equipped  than  the  preceding. 

3.  "Ambulanze  di  Montagna."  These  are  located  from  2  to  5 
kilometers  behind  the  front,  and  are  the  most  advanced  point 
reached  by  the  Italian  Red  Cross. 

4.  "Stazioni  di  Sanita."  These  are  somewhat  larger  and  better 
equipped  than  the  preceding.  Tetanus  antitoxin  is  usually  given 
here. 

5.  "Ospedali  da  Campo"  or  Field  Hospital.  These  hospitals  are 
located  in  convenient  and  accessible  points  somewhat  farther 
back.  At  the  outset  of  the  war  they  were  of  50-bed  capacity,  but 
experience  soon  showed  that  it  was  frequently  necessary  that  they 
be  of  500-bed  capacity.  They  are  now  also  used  as  Smistamento, 
or  distributing  centers,  at  which  patients  are  classified  and  sent 
to  the  various  special  hospitals. 

6.  "Ospedali  di  Tappa."  These  are  base  hospitals,  and  may 
be  located  several  hundred  kilometers  behind  the  lines.  They  are 
usually  grouped,  so  that  in  one  village  or  town  or  area  there  may 
be  a  bed  capacity  varying  from  20,000  to  40,000. 

7.  "Ospedali  di  Riserva."  These  hospitals  are  institutions  or 
other  large  buildings  located  throughout  the  cities  of  Italy  which 
have  been  made  available  for  the  reception  of  soldiers. 

The  whole  question  of  handling  the  wounded  is  still  in  a  transi- 
tional state.  Many  hospitals,  however,  have  been  actually  brought 
near  the  front-line  trenches. 

For  each  army  there  are  a  number  of  large  quarantine  or  dis- 
infecting stations,  equipped  for  the  treatment  and  detention  of 
soldiers  that  have  come  from  areas  in  which  dangerous  communi- 
cable diseases  have  prevailed,  as  for  instance,  cholera,  malaria, 
dysentery  and  typhoid.  These  stations  are  provided  with  steam 
disinfecting  apparatus  or  sulphur  dioxide  chambers,  or  other  means 
for  disinfecting  clothing  and  equipment. 


18  MODERN  ITALIAN  SURGERY 

Special  effort  is  made  to  sterilize  textiles  which  have  become  in- 
fected, and  particularly  those  which  may  have  become  infected 
with  body-lice  or  their  eggs.  Every  patient,  before  being  admitted 
to  one  of  the  general  hospitals,  is  detained  at  a  quarantine  station 
for  a  sufficient  time  to  permit  several  microscopic  examinations 
of  the  stool. 

All  prisoners,  likewise,  are  passed  through  stations  of  this  kind. 

HOSPITALS 

Construction.  The  hospital  accommodation  afforded  by  the 
Italian  Red  Cross  consists  largely  of  converted  tourist  hotels, 
schools  and  other  large  buildings  which  could  be  adapted  to  the 
purpose. 

The  hospitals  provided  by  the  medical  service  of  the  army  con- 
sist of  existing  army  hospitals,  many  of  which  have  been  expanded, 
converted  military  buildings,  or  entirely  new  buildings  erected  for 
hospital  purposes.  The  latter  are  usually  one-story  pavilions 
about  14  feet  high,  18  feet  wide,  and  of  any  desired  length,  con- 
structed of  angle  iron  placed  on  6-foot  centers,  with  the  interven- 
ing space  filled  in  with  hollow  tile.  The  tile  resembles  that  used  in 
fireproof  construction  in  this  country.  The  roofs  also  are  of  tile. 
Building  of  this  type  can  be  rapidly  constructed,  and  hundreds 
of  beds  can  be  provided  in  a  week  or  two.  Over  the  course  of  a  year 
or  more,  they  are  much  cheaper  than  tentage.  They  are  cool  in 
summer  and  can  be  kept  warm  in  winter.  It  is  noteworthy  that  one 
seldom  sees  patients  cared  for  in  tents  in  Italy. 

The  decreased  use  of  cavalry  in  this  war  has  made  available 
large  numbers  of  cavalry  barracks.  These,  when  renovated,  lend 
themselves  to  hospital  purposes.  At  Udine,  for  instance,  one  of 
the  cavalry  barracks  has  been  made  into  a  single  hospital  ward  with 
300  beds.  The  proportions  of  this  ward  are  immense.  From  one  end 
of  the  room  it  is  almost  impossible  to  see  a  bed  located  at  the 
other. 

Hospital  Locations.  Hospitals  have  been  located  nearer  and 
nearer  the  front,  as  it  has  been  deemed  advisable  to  risk  the 
occasional  danger  from  shells,  in  view  of  the  great  advantage  in 
having  immediate  treatment  available  for  the  injured.  One  finds 


THE  AMERICAN  RED  CROSS  IN  ITALY  19 

these  hospitals  in  most  unusual  positions.  It  was  a  novel  experi- 
ence to  be  taken  30  or  40  feet  underground,  and  there  at  a  point 
directly  over  which  a  battle  was  raging,  to  see  the  regular  hospital 
routine  going  on  in  good  operating  rooms  and  wards  supplied 
with  artificial  ventilation  and  modern  hospital  furniture,  and, 
in  general,  admirably  adapted  to  the  purpose. 

To  go  to  the  other  extreme,  at  an  elevation  of  6,000  feet  in  the 
Dolomites,  we  came  on  a  hospital  of  30-bed  capacity  hewn  out  of 
the  side  of  a  cliff.  The  two  side  and  back  walls  were  of  stone,  and  the 
mountain  range  at  this  point  was  so  narrow  that  through  a  hole 
bored  in  the  back  wall  of  the  hospital  it  was  possible  to  look  into 
the  Austrian  trenches  on  the  other  side  of  the  mountain.  This  hos- 
pital may  be  said  to  be  on  the  front-line  trenches.  The  wounded  that 
were  able  to  travel  after  receiving  emergency  treatment  were  sent 
to  the  rail  head  on  the  marvellous  teleferica,  which  often  go  from 
mountain  top  to  mountain  top  over  chasms  thousands  of  feet 
deep. 

Hospital  Specialization.  Specializing  has  been  carried  to  a 
high  degree.  For  instance,  at  Udine,  we  saw  1,500  fracture  patients 
in  a  single  hospital.  At  other  hospitals  we  saw  under  treatment 
only  patients  with  gunshot  wounds  of  the  chest.  One  hospital  had 
70,000  admissions  during  the  month  of  August,  which  corresponded 
to  a  period  of  active  offensive  operations.  Some  of  the  hospitals 
are  so  large  that  a  motor  car  is  required  to  visit  the  various 
buildings. 

Great  progress  has  been  made  in  developing  the  technique.  We 
were  told  for  instance,  that  at  the  hospital  in  charge  of  Dr.  Bastian- 
elli,  Professor  Morelli  had  invented  an  improved  aspirator  for 
draining  fluid  from  the  chest.  Pressure  within  and  without  the 
lungs  can  accurately  be  read  on  a  gage,  and  through  the  develop- 
ment of  special  technique,  which  among  other  things  permits  the 
lungs  to  remain  collapsed  during  definite  periods,  he  has  been  able 
to  produce  some  startling  results  in  connection  with  lung  surgery. 
Professor  Morelli  informed  us  that  he  had  recently  completed  100 
cases  without  mortality.  He  believes  it  to  be  entirely  feasible  to 
keep  the  mortality  well  under  5  per  cent,  in  all  gunshot  wounds  of 
the  chest. 


20  MODERN  ITALIAN  SURGERY 

Roentgen-ray  Apparatus.  At  the  time  Italy  went  to  war 
few  factories  existed  for  the  production  of  hospital  and  medical 
supplies.  There  was,  for  instance,  scarcely  a  roentgen-ray  appara- 
tus in  the  country  that  had  not  been  made  in  Germany.  At  pres- 
ent, practically  every  hospital  throughout  Italy  has  one  or  more 
roentgen-ray  machines,  all  manufactured  in  Italy.  Not  only  is  the 
apparatus  as  good  as  that  formerly  imported,  but  many  competent 
observers  believe  it  to  be  far  superior. 

Ambulance  Service.  A  remarkably  efficient  ambulance  ser- 
vice has  been  established.  With  the  exception  of  a  few  cars  fur- 
nished through  the  British  Red  Cross,  all  the  ambulances  have 
been  supplied  by  the  Italian  Red  Cross  or  the  Italian  Government. 
Owing  to  the  mountainous  character  of  the  service  required, 
heavier  cars  have  been  found  to  be  most  practical.  During  active 
engagement  the  empty  ambulances  going  to  the  front  carry  many 
additional  stretchers.  These  are  filled  and  placed  in  the  empty 
camions  that  have  taken  ammunitions  or  other  supplies  to  the 
front.  Since  a  modern  war  is  largely  a  problem  of  transportation, 
this  reduces  the  number  of  vehicles,  prevents  congestion  of  the 
roads,  and  affords  prompt  service  for  returning  the  wounded  from 
the  most  advanced  points  at  the  front. 

Hospital  Trains.  The  smooth  organization  of  the  hospital 
train  service  was  one  of  the  most  striking  features  that  we  saw  in 
Italy.  Both  the  Italian  Red  Cross  and  the  Army  Medical  Service 
provide  such  trains.  There  is  indeed  considerable  rivalry  between 
these  two  organizations  as  to  which  can  furnish  the  most  prompt 
and  efficient  evacuation. 

In  a  number  of  instances  we  saw  a  train  back  into  a  side  track 
next  to  a  hospital,  take  on  board  350  wounded,  and  in  less  than 
thirty  minutes  proceed  on  its  way.  There  was  no  confusion,  and 
everything  seemed  to  work  with  clock-like  precision. 

i         new  inventions 

One  is  particularly  impressed  by  the  large  amount  of  new  appara- 
tus that  has  been  invented.  Formerly,  Zander  or  similar  apparatus 
mostly  came  from  Germany.  Not  only  are  all  these  now  manu- 
factured in  Italy,  but  a  large  number  of  new  machines  have  been 


THE  AMERICAN  RED  CROSS  IN  ITALY  21 

invented  to  meet  the  needs  of  war  cripples.  We  saw  an  ingenious 
pneumatic  tourniquet,  new  apparatus  for  jaw  surgery,  improve- 
ments in  artificial  limbs,  and  many  other  things  too  numerous  to 
mention. 

Re-education  Institutions.  The  Rizzoli  Institute  in  Bo- 
logna, created  many  years  before  the  war,  had  considerable  dis- 
tinction for  its  prosthetic  appliances  and  method  of  re-education 
for  lost  functions. 

Almost  unbelievable  progress  in  these  directions  has  been  made. 
The  Regina  Margherita  Hospital,  or  Institute  for  Physical  Re- 
education in  Rome,  will  compare  favorably  with  the  best  of  similar 
institutions  anywhere.  This  institution  has  a  capacity  of  1,200 
patients.  Of  these,  700  are  in  the  physical  therapy  division.  About 
600  patients  are  discharged  per  month.  Some  of  the  passive  exercise 
machines  that  have  been  developed  are  very  ingenious.  Great 
stress  is  laid  on  specialized  forms  of  physical  drill  for  rehabilitating 
nerve  function. 

We  were  shown  some  very  truly  remarkable  results  in  this  direc- 
tion. The  Villa  Mirafiore,  which  belongs  to  the  American  Academy 
in  Rome,  has  been  set  aside  as  an  institute  for  mutilated  soldiers. 
It  is  directed  by  Dr.  Guali,  who  has  devised  most  excellent  im- 
provements in  artificial  limbs.  It  is  said  that  at  the  outset  of  the 
war  practically  all  the  limbs  had  to  be  purchased  in  America,  but 
now  almost  all  are  manufactured  in  Italy  at  a  great  saving  in  cost. 
Dr.  Guali  has  invented,  likewise,  an  ingenious  apparatus  for  regis- 
tering the  pressure  of  the  artificial  foot.  This  apparatus  enables 
him  so  to  modify  the  limb  construction  as  to  bring  the  pressure 
to  bear  similar  to  that  of  the  human  foot.  Certainly,  some  of  his 
results  were  most  striking.  At  the  Rizzoli  Institute  in  Bologna, 
we  saw  a  soldier  who  had  been  blinded  in  both  eyes  and  had  lost 
both  hands,  yet  who,  by  the  use  of  an  apparatus  devised  especially 
for  him,  was  able  to  use  a  knife,  fork  and  spoon. 

At  other  institutions,  after  the  lost  function  had  been  partially 
restored,  a  trade  suitable  to  the  condition  of  the  individual  patient 
is  taught.  Typewriting,  printing,  wood  carving,  lathe  work, 
tinsmithing,  basketmaking,  and  even  primary  education,  are  taught 
at  these  various  places. 


22  MODERN  ITALIAN  SURGERY 

QUARANTINE   STATIONS 

In  addition  to  the  quarantine  stations  heretofore  mentioned 
as  being  located  in  northern  Italy  directly  in  connection  with  the 
various  hospitals  at  the  front,  there  are  in  southern  Italy  huge 
quarantine  stations  which  for  size  will  probably  long  hold  world 
records. 

Equipment  for  steam  and  sulphur  fumigations,  as  well  as 
detention  barracks,  have  been  provided.  For  instance,  the  French, 
in  order  to  take  care  of  the  soldiers  returning  from  Saloniki  and 
eastern  fronts,  have  in  southern  Italy  built  a  quarantine  station  for 
40,000  persons. 

The  British  constructed  a  station  for  20,000  soldiers  for  the  same 
purpose.  At  these  stations  careful  examinations  are  made  for 
cholera,  typhoid  and  dysentery  carriers.  Blood  examinations  are 
also  made  in  order  to  detect  malaria.  Soldiers  found  infected  are 
treated  before  being  allowed  to  return  to  Great  Britain  or  France. 
Italy  has  established  huge  stations  for  the  return  of  her  soldiers 
from  Saloniki  and  Albania.  When  it  is  stated  that  over  100,000 
malaria  patients  have  been  invalided  back,  the  importance  of  these 
huge  quarantine  stations  is  at  once  manifest. 

LABORATORIES 

Laboratory  work  on  a  gigantic  scale,  and  especially  on  the  pre- 
ventive side,  has  become  an  intimate  part  of  the  medical  system 
in  the  present  war.  The  examination  of  the  stool  for  cholera, 
typhoid  and  dysentery  has  entailed  an  enormous  amount  of  work. 

With  the  exception  of  the  cholera  imported  into  Italy  at  the 
beginning  of  the  war  through  Austrian  prisoners,  that  disease  has 
not  since  made  its  appearance.  Yet  cholera  carriers  are  constantly 
detected.  This  gives  one  an  idea  of  the  wonderful  protection 
afforded  by  a  modern  health  service. 

TUBERCULOSIS 

Considering  the  size  of  the  Italian  army,  a  comparatively  small 
amount  of  tuberculosis  has  been  encountered.  It  is  stated  that 
about  5,000  cases  appeared  among  the  4,000,000  troops.  However, 
it  is  said  that  more  than  30,000  tuberculous  Italian  prisoners  had 


THE  AMERICAN  RED  CROSS  IN  ITALY  23 

been  returned  from  Austria.  The  care  of  these  patients  is  now  re- 
ceiving much  earnest  attention. 

Almost  from  the  beginning  roentgen-ray  diagnosis  was  used  in 
the  detection  of  incipient  tuberculosis.  This  form  of  diagnosis  has 
now  become  the  routine  procedure.  New  recruits  are  carefully 
examined  before  being  admitted  to  the  army;  and,  as  rapidly  as 
facilities  permit,  those  suspected  of  being  infected  are  examined 
with  the  roentgen  ray. 

RECLAMATION 

Among  other  activities  with  which  the  medical  service  is  associ- 
ated is  an  active  reclamation  department.  The  variety  and  quantity 
of  articles  removed  from  a  modern  battlefield  are  almost  unbeliev- 
able; they  include  shoes,  clothing,  gas-masks,  first-aid  packages, 
brass,  shells,  parts  of  guns,  motor  trucks,  and  almost  every  other 
conceivable  thing. 

As  soon  as  practical  after  a  battle,  all  this  paraphernalia,  or  as 
much  as  it  is  possible,  is  collected  from  the  field  and  taken  to  a 
central  depot.  Here  it  is  sorted  and  sent  to  the  various  factories  for 
repairs.  Gas-masks,  for  instance,  are  sent  to  a  gas-mask  repair 
factory,  where  the  necessary  mending  is  done  and  the  mask 
reissued.  Shoes  are  disinfected,  cleaned  and  reissued.  If  in  need 
of  cobbling,  two  pairs  of  shoes  are  often  made  into  one.  The  same 
obtains  in  regard  to  clothing.  There  are  huge  disinfecting  plants 
and  laundries  in  connection  with  these  reclamation  stations,  for 
the  treatment  of  articles  for  personal  use.  Most  of  the  workers  in 
these  establishments  are  women,  many  of  whom  are  recruited  from 
among  the  fallen  classes. 

FIRELESS   COOKERS 

One  of  the  striking  features  in  connection  with  the  provisions  of 
suitable  food  for  the  soldiers  in  the  front-line  trenches  is  the  very 
general  employment  of  huge  fireless  cookers. 

This  enables  the  food  to  be  prepared  in  permanent  kitchens 
well  behind  the  line,  and  assures  to  the  soldier  absolutely  hot 
meals  no  matter  how  advanced  the  position  in  which  he  finds 
himself. 


24  MODERN  ITALIAN  SURGERY 

Huge  shops  for  repairing  and  refitting  these  cookers  form  part 
of  the  system. 

PRISON   CAMPS 

The  prison  camps  at  the  front  consist  of  barbed  wire  enclosures 
with  good  tents  and  excellent  cooking  arrangements.  They  are 
divided  into  three  sections.  The  first  is  the  reception  enclosure 
in  which  the  prisoners  are  bathed  and  their  clothing  disinfected. 
They  are  then  passed  into  the  second  enclosure,  where  stool 
specimens  are  taken  for  cholera,  dysentery  and  typhoid.  After 
three  days'  detention  in  the  second  enclosure,  those  whose  stools 
are  negative  are  sent  into  the  third  where  they  remain  perhaps 
several  weeks  until  arrangements  can  be  made  to  transfer  them  to 
permanent  locations  in  the  interior.  For  the  officers,  houses  of  a 
semi-permanent  character  are  provided.  One  is  greatly  impressed 
by  the  kindliness  and  consideration  which  are  shown  to  the 
prisoners  of  all  classes.  The  food  is  the  same  as  given  to  the  Italian 
officer  or  soldier  of  corresponding  grade.  No  work  is  required  of 
officers. 

VENEREAL  DISEASES 

No  actual  official  records  dealing  with  venereal  disease  in 
the  army  were  available.  At  the  front,  however,  in  each  army  there 
are  special  hospitals  for  the  treatment  of  these  patients.  The 
officers  and  men  are  not  permitted  to  associate  with  any  women 
who  are  not  under  governmental  supervision.  The  medical  officers 
stated  that  venereal  disease  had  been  reduced  to  almost  negligible 
proportions. 

MEDICAL  SCHOOL  AT  THE  FRONT 

Among  many  other  novelties  introduced  by  the  Italian  medical 
service  is  the  establishment  of  a  complete  medical  school  near 
the  front-line  trenches.  The  character  of  the  fighting  up  to  the 
present  winter,  has  made  this  possible.  From  the  beginning  of  the 
war  until  the  autumn  of  1917,  practically  all  the  active  military 
work  was  done  between  April  and  November.  During  the  remaining 
months  when  the  army  was  comparatively  inactive,  all  the  medical 
students  who  were  serving  in  the  hospital  corps  or  other  branches, 


THE  AMERICAN  RED  CROSS  IN  ITALY  25 

were  ordered  to  San  Giorgio  di  Nogaro,  at  which  point  professors 
from  the  various  medical  schools  who  are  in  the  army,  also  assem- 
bled. These  professors  were  assigned  to  look  after  the  sick  in 
the  vicinity  of  the  school.  This  enabled  them  to  use  the  clinical 
material  for  the  benefit  of  the  students.  The  buildings  were  mostly 
of  temporary  construction,  but  well  adapted  to  the  purpose.  Enor- 
mous collections  of  bones  and  pathologic  material  generally,  which 
had  accumulated  as  a  result  of  the  war,  were  assembled  there. 

EFFICIENCY 

Finally  it  may  be  stated  that  we  were  much  impressed  by  the 
excellent  care  given  to  the  wounded,  and  the  spirit  of  service  mani- 
fested by  the  medical  officers.  They  were  on  duty  early  and  late, 
never  sparing  themselves,  quick  to  meet  emergent  needs,  and 
through  it  all  a  wonderful  fellowship  and  mutual  helpfulness 
prevailed. 

Note:  The  American  Red  Cross  Commission  to  Italy  was 
composed  of  George  F.  Baker,  Jr.;  John  Morron;  Nicholas  F. 
Brady;  Dr.  Thomas  W.  Huntington  and  Dr.  Victor  G.  Heiser.  It 
sailed  July  28,  191 7,  and  returned  to  this  country  on  October  22, 
191 7.  After  visiting  institutions  in  England  and  France  connected 
with  the  war,  the  commission  was  given  unusual  facilities  for 
visiting  the  French  and  British  fronts  in  France. 

It  then  spent  five  weeks  in  Italy  studying  the  conditions  to 
determine  how  the  American  Red  Cross  could  render  the  most 
efficient  aid  to  Italy.  Several  weeks  were  spent  at  the  Italian  front. 
Later  visits  were  made  practically  to  all  the  centers  in  Italy  and 
Sicily  at  which  the  wounded  were  cared  for.  These  extended  visits 
enabled  the  members  to  gain  personal  first  hand  information  and  to 
form  an  idea  of  the  value  of  the  work  of  the  Italians,  compared  to 
that  seen  on  the  French  and  the  British  fronts. 


Chapter  III 

THE  SANITARY  SERVICE  OF  THE  ITALIAN 
ARMY  DURING  THE  WAR 

ONE  of  the  Army  organizations  which  has  shown 
a  surprising  efficiency  during  the  last  war,  was 
the  Sanitary  Corps.  It  was  not  a  new  organi- 
zation, for  there  existed  a  special  regulation 
on  the  Army  Sanitary  Service,  which  had  done  good 
work  in  the  Libyan  War,  and  was  recognized  in  19 15 
under  special  rules  (Servizio  di  Guerra). 

Gen.  Francesco  Testi,  who  was  director  of  the  Mili- 
tary Sanitary  School  in  Florence,  and  the  author  of  an 
excellent  book  on  microbiology1  wrote  an  article  (Janu- 
ary, 1 91 7)  in  which  he  described  from  the  beginning 
the  wonderful  display  of  national  energy  in  answer  to 
the  urgent  appeal  of  the  country  for  an  adequate  pro- 
vision in  the  immediate  emergency. 

A  great  many  new  factors  contributed  to  the  develop- 
ment of  the  Sanitary  Service — principally,  the  revolu- 
tion in  the  method  of  warfare  establishing  trench 
organization  with  slow  advancement,  the  vastness  of 
the  front  which  necessitated  a  large  distribution  of 
ready  means  of  medical  help  and  advanced  hospitals, 
the  rapid  formation  of  a  large  army,  the  threatening 
epidemics  and  the  increasing  rapport  between  the  war 
zone  and  the  nation. 

^icrobiologia  Pura  ed  Applicata,  con  speciale  riguardo  alia  Tecnica  Micro- 
biologia,  per  Studenti  e  Medici,  191 1. 

26 


SANITARY  SERVICE  OF  THE  ITALIAN  ARMY     27 

Under  these  conditions,  so  different  from  those  experi- 
enced in  any  previous  war,  the  Sanitary  Organization 
had  to  find  its  way  amid  new  problems  and  new  diffi- 
culties. But  the  unanimous  and  harmonious  will  of  the 
men  who  realized  the  supreme  necessity  of  a  prompt 
and  steady  cooperation,  greatly  helped  to  overcome 
the  enormous  needs  which  confronted  the  authorities 
day  by  day,  anxious  of  maintaining  intact  the  spirit  of 
the  regular  army  corps,  by  disciplining  the  new  recruits 
into  the  regulations  to  which  they  were  not  accustomed. 

To  these  already  difficult  conditions  the  Sanitary 
Corps  had  to  add  the  necessary  study  of  complex 
modern  medico-legal  problems,  the  economic  side  of 
which  included  responsibility  for  many  "after-war" 
cases,  involving  different  studies  of  new  pathologic 
forms  and  requiring  special  treatment  and  special 
hospitals.  In  such  a  contingency  the  Sanitary  Corps  had 
to  engage  some  elements  among  the  civil  medico-legal 
authorities,  selecting  specialists  of  the  different  clinics, 
men  of  science,  practical  men,  ready  and  able  to  co- 
operate in  the  difficult  task  of  selecting,  separating, 
rehabilitating  and  justly  discharging  the  normal  and 
the  abnormal  subjects  of  such  a  big  army. 

The  service  of  the  Sanitary  Corps  depends  upon  the 
Army  Quartermasters  in  its  technical  administrative 
parts,  and  is  divided  into  two  sections,  that  of  the  first 
line,  which  is  attached  to  the  army  corps,  and  that  of 
the  second  line,  which  is  practically  of  the  Reserve  and 
is  attached  to  the  Minister  of  War. 

The  Sanitary  Corps  is  not  a  new  organization,  simply 
an  improvement  and  extention  of  a  previously  organized 
body,  with  the  application  of  all  the  new  requirements 


28  MODERN  ITALIAN  SURGERY 

that  science  and  experience  could  suggest.  It  is  difficult 
to  enumerate  the  many  modifications  adopted  for  the 
present  needs,  but  it  is  well  to  differentiate  the  various 
sections  of  the  complex  service:  (i)  Assistance  and 
treatment  of  wounded  and  sick  of  the  first  line,  in  the 
firing  zone,  and  immediately  in  the  rear.  (2)  Removal 
of  the  wounded  and  sick.  (3)  Sanitary  materials.  (4) 
Various  sanitary  services.  (5)  Hygiene  of  the  troops. 
(6)  Prophylactic  sanitary  service. 

ATTENDANCE  AND  TREATMENT  OF  WOUNDED  AND 
SICK  IN  THE  FIRST  LINE 

The  trench  warfare  with  the  long  permanence  of 
troops  in  one  place  has  greatly  modified  the  old  method 
of  assistance  to  the  wounded  and  sick  soldiers.  The  old 
system  of  a  carriage  standing  in  the  rear,  ready  to  move 
on  or  back,  and  of  the  surgical  post  around  a  tent,  also 
ready  to  be  moved,  exists  no  more. 

The  place  of  the  first  dressing  is  in  the  trenches,  and 
the  first  urgent  operations  are  performed  in  the  trenches, 
in  some  special  locality  along  the  line,  sometimes  far 
along  the  tortuous  tunnelling,  before  the  sick  or  wounded 
are  carried  to  the  stationary  section  in  the  rear.  There 
is  the  advanced  hospital,  the  place  which  is  most 
important  and  most  trying  on  account  of  the  sudden 
appearance  of  many  wounded  sent  to  the  nearest  place 
for  the  real  surgical  work,  before  they  can  be  removed 
to  the  large  permanent  hospital.  Experience  soon  made 
it  possible  to  fix  in  the  trenches,  rooms  well  equipped 
for  the  urgent  needs  of  dressing  patients  before  moving 
them  to  the  rear  by  means  of  stretchers  with  ambu- 
lances and  autocars. 


SANITARY  SERVICE  OF  THE  ITALIAN  ARMY     29 

While  the  means  of  transportation  made  possible 
the  rapid  removal  of  the  wounded,  small  hospitals  and 
special  sections  for  infectious  diseases  were  established 
as  near  to  the  front  as  possible,  which,  by  the  patient 
work  of  energetic  surgeons,  soon  became  important 
centers  of  treatment  and  operations,  giving  shelter  to 
as  many  as  200  patients  at  one  time. 

Worthy  of  praise  were  the  two  hospitals  designed 
and  put  into  working  shape  by  Prof.  Baldo  Rossi 
of  Milan;  these  could  be  set  up  in  less  than  six  hours' 
time  and  were  especially  devoted  to  the  urgent  treat- 
ment of  abdominal  and  thoracic  cases  with  severe 
hemorrhage.  Similar  to  these  of  Prof.  Baldo  Rossi, 
were  the  five  surgical  ambulances,  established  by  the 
Minister  of  War,  assigned  to  the  army  corps,  which  also 
attended  to  the  urgent  cases  of  abdominal  and  thoracic 
wounds. 

REMOVAL  OF  SICK  AND  WOUNDED 

The  hand  stretchers,  the  two-wheel  and  the  motor- 
cycle stretchers  are  the  handy  means  of  transportation 
of  modern  warfare,  but  in  the  mountain  attack  at  the 
Italian  side,  sleigh  stretchers  were  used  in  conjunction 
with  aerial  wire  ropes,  over  which  baskets  could  slide 
from  one  mountain  to  another  or  down  to  the  valley 
(Teleferiche) . 

But  these  means  of  transportation  were  only  used 
from  the  immediate  front  and  for  short  distances, 
while  for  the  removal  to  the  larger  hospitals  (terri- 
torial or  reserve),  sanitary  trains  were  especially 
adapted  for  transport,  with  special  accomodations  for 
certain  kinds   of  wounded,  according  to  the  distance. 


30  MODERN  ITALIAN  SURGERY 

For  longer  trips,  special  trains  were  equipped  with 
appropriate  rooms  for  medication,  a  small  kitchen  and 
all  the  comforts  needed  on  the  way.  For  infectious 
diseases  special  trains  were  used,  thoroughly  dis- 
infected before  their  return  trip. 

The  quartermaster  had  entire  charge  of  and  responsi- 
bility for  the  regular  running  of  the  trains,  and  for 
the  personnel  working  under  him,  while  the  Sanitary 
Corps  was  responsible  for  the  sanitation.  The  work  of 
evacuation  of  wounded  and  sick  soldiers  from  the  small 
to  the  large  military  and  territorial  hospitals  always 
proceeded  with  perfect  order  and  discipline. 

MATERIALS   AND   SANITARY   SUPPLIES 

The  military  authorities  were  equal  to  the  urgent 
demand  for  sanitary  supplies  which  were  amply  pro- 
vided according  to  the  most  modern  requirements, 
from  stretchers  that  were  continually  improved,  to  the 
radio-apparatus,  so  as  to  have  every  small  hospital 
at  the  front  well  supplied  with  the  best  material  ob- 
tainable, notwithstanding  the  sudden  and  pressing 
call  on  the  nation's  resources  and  the  difficulty  in 
getting  such  a  large  amount  of  material  with  a  limited 
number  of  factories  at  home,  and  from  foreign  countries 
also  engaged  in  the  same  struggle.  But  the  nation 
was  equal  to  the  emergency,  and  factories  were  soon 
multiplied,  supplying  surgical  instruments  and  dress- 
ings, and  enlarging  automobile  and  truck  factories  with 
marvellous  rapidity. 

Large  stores  were  built  throughout  Italy  for  the 
prompt  distribution  of  the  different  supplies  needed 
for  the  big  army. 


SANITARY  SERVICE  OF  THE  ITALIAN  ARMY     31 

SPECIAL    SANITARY   SERVICES 

One  of  the  most  humanitarian  improvements  accom- 
plished by  the  present  war  has  been  the  specialization 
of  nervous  diseases,  the  formation  of  psychopathic  and 
neurologic  departments  for  the  study  of  all  sorts  of 
nervous  disturbances,  aggravated  by  military  life  or 
by  camp  influence  and  circumstances,  and  nervous 
lesions  consecutive  to  traumatic  injuries  in  service*or 
in  battles. 

The  medical,  surgical  and  medico-legal  side  of  such 
delicate,  valuable  studies  were  conducted  not  only 
from  a  scientific  but  also  from  a  practical  point  of  view, 
and  the  results  have  been  most  gratifying. 

Another  very  important  service  which  produced 
most  valuable  results  was  the  stomato-odontoiatric 
department,  which  rapidly  became  a  hygienic  necessity 
for  the  army. 

Similar  special  departments  were  established  for 
syphilitic  and  skin  diseases,  and  for  eye,  nose  and 
throat  troubles. 

Soldiers  were  instructed  for  the  special  work  of  dis- 
infection, and  these  were  scattered  along  the  different 
railroad  stations,  ready  for  the  service  of  disinfection 
to  combat  any  fresh  manifestation  of  epidemics. 

A  corps  of  specialists  in  bacteriologic  work  was  sent 
to  the  various  laboratories,  provided  with  abundant 
material  for  research  and  examinations. 

HYGIENE   OF   THE   TROOPS 

The  modern  war  of  trenches  necessitates  a  period  of 
rest,  during  which,  besides  the  physical  and  mental 


32  MODERN  ITALIAN  SURGERY 

rest,  the  soldier  has  a  chance  to  undergo  a  thorough 
cleaning,  general  restoration  to  normal  life,  and  pre- 
paration to  return  to  the  front. 

The  work  in  the  trenches  has  been  a  new  study  of 
cement  and  architectural  devices  to  make  life  possible 
and  tolerable  during  the  hard  winters  and  the  rainy 
seasons,  beside  the  difficult  attempt  to  keep  the  narrow 
shelter  clean  and  free  from  vermin  and  all  sorts  of 
infections.  Special  rooms  were  built  for  temporary 
treatment  of  simple  diseases,  and  storerooms  for  medi- 
cines and  provisions  necessary  during  such  a  hard  life. 
An  abundant  provision  of  filters  of  every  kind  and 
different  means  of  purifying  the  water  were  placed  at 
the  disposition  of  the  Sanitary  Corps  and  freely 
distributed  along  the  trenches,  where  frequent  examina- 
tions were  made  to  ascertain  the  potability  of  the 
water. 

PROPHYLACTIC  SERVICE 

It  is  well  known  that  one  of  the  most  common  dangers 
deriving  from  a  war  is  an  epidemic  which  can  spread 
either  from  the  civilian  population  or  from  the  army. 

One  of  the  most  important  tasks  of  the  Government 
was  to  keep  a  very  careful  watch  over  the  sanitary  con- 
dition of  the  civil  population  through  which  the  army 
corps  had  to  pass  in  the  continual  dislocation  of  sol- 
diers for  the  strategic  movement  of  troops.  This  difficult 
and  complicated  work  of  the  civil  and  military  author- 
ities was  accomplished  by  mutual  accord,  and  recipro- 
cated help  in  which  the  strong  patriotic  sentiment  for 
the  country  always  prevailed. 

In  this  way  several  threatening  dangers  of  epidemics 


SANITARY  SERVICE  OF  THE  ITALIAN  ARMY     33 

were  checked  at  the  very  beginning,  thanks  to  the  most 
complete  organization  formed  by  a  representative  of 
the  general  Department  of  Public  Health,  some  super- 
ior officers  of  the  Army,  a  general  from  the  Army  Staff  of 
Quartermasters-General.  From  that  great  body,  sev- 
eral subcommissions  attended  to  the  provisions  in  the 
different  districts  and  sections. 

A  sort  of  vigilant  commission  presided  over  the  work 
of  evacuating  the  different  hospitals  at  the  front, 
watching  carefully  the  distribution  of  every  patient 
so  as  to  prevent  the  danger  of  spreading  infectious 
diseases  among  healthy  communities. 

To  dispose  of  suspicious  cases,  several  hospitals  of 
observation  were  organized  and  equipped  with  bacterio- 
logical laboratories  in  which  patients  were  quarantined. 
At  the  most  advanced  zone  a  movable  disinfecting 
train,  carrying  baths  and  special  stoves  invented  by  a 
genial  Italian  officer  for  rapid  disinfections  of  parasites, 
was  placed  at  the  disposal  of  the  military  authority. 

Hospitals  for  exotic  diseases  and  others  for  convales- 
cents were  organized  not  far  from  the  fighting  zone  and 
located  in  the  most  convenient  positions  for  that 
purpose. 

Prisoners  and  working  men  employed  by  the  army 
were  continually  under  strict  observation,  since  they 
were  the  refugees  of  provinces  occupied  by  the  enemy. 

Of  all  the  work  done  by  the  different  sections  a 
careful  report  was  regularly  transmitted  to  the  central 
organization  with  remarks  and  modifications  suggested 
by  the  circumstances,  so  as  to  keep  the  field  open  for 
additional  improvements. 


Chapter  IV 

A  SCHOOL  OF  MEDICINE  AND  SURGERY 
DURING  THE  WAR 

AS  soon  as  Italy  entered  the  war,  the  necessity 
for  providing  a  sufficient  Medical  Corps  for 
such  a  large  army,  compelled  the  Minister 
of  Public  Education,  upon  whom  depend  all 
the  universities,  to  issue  an  order  for  an  acceleration 
course  of  studies  for  the  medical  student  of  the  sixth 
year.  But,  in  view  of  the  possible  length  of  the  war,  it 
became  urgent  to  provide  for  the  education  of  the 
students  of  the  fifth  year,  drafted  at  the  front  for  regular 
service,  so  as  to  save  them  from  losing  their  coveted 
time  of  study,  and  likewise  prepare  them  for  efficient 
assistance  in  the  service. 

San  Giorgio  di  Nogaro,  a  small  town  near  the  front, 
was  selected  and  several  buildings  of  appropriate  light 
structure  were  erected  with  all  the  necessary  sections 
for  lectures,  laboratories,  dissecting  rooms,  operating 
rooms  and  annexes  required  for  a  well-organized 
school. 

The  school  was  inaugurated  on  February  13,  191 6, 
with  sixteen  different  courses,  the  principal  being:  the 
Surgical  Clinic  and  Operative  Medicine,  directed  by 
Prof.  Giuseppe  Tusini  of  the  University  of  Modena; 
War  Traumatology,  directed  by  Prof.  Lorenzo  Bonomo 
of  Rome;  Prosthesis  and  Surgery  of  the  Limbs,  Prof. 
Bartolo  Nigrisoli  of  Bologna;  followed  by  those  of 

34 


A  SCHOOL  OF  MEDICINE  AND  SURGERY         35 

medicine  and  the  different  specialties.  The  professors 
were  assisted  by  the  free  docents  who  were  in  service. 

Everything  was  organized  according  to  the  military 
method  and  discipline,  and  the  students  were  given 
every  opportunity  for  practical  instruction  in  the  dif- 
ferent wards  of  the  nearby  hospitals  crowded  with  every 
kind  of  surgical  and  medical  patient.  Abundant  ma- 
terial for  autopsy,  dissections  and  pathological  work 
was  utilized  in  different  sections,  especially  built  and 
adapted. 

Three  hundred  and  fifty-six  students  of  the  fifth 
year  and  ten  of  the  sixth,  from  various  universities  of 
the  kingdom,  took  advantage  of  the  school  of  San 
Giorgio  di  Nogaro,  in  which  245  autopsies  were  made 
by  the  teacher  of  pathologic  anatomy,  and  5,977 
patients  were  used  for  clinical  instruction  in  every 
subject,  with  the  great  advantage  of  comparative 
studies  in  each  case. 

The  favorable  condition  of  the  quiet  little  town  and 
the  compact  arrangement  of  the  buildings  for  lectures, 
laboratories,  clinical  and  experimental  work,  made  it 
convenient  and  easy  for  the  teachers  to  attend  to  their 
scientific  and  practical  work. 

The  final  result  of  the  experiment  fully  justified  the 
large  expense  and  the  trouble  in  organizing  the  insti- 
tution. For,  if  the  pupils  of  San  Giorgio  di  Nogaro  had 
been  left  to  their  regiments,  and  to  the  menial  work 
of  soldiers,  they  would  have  been  lost  to  the  profession 
for  lack  of  tuition,  and  their  valuable  help  would 
have  been  lacking  in  the  work  of  the  much-needed 
medical  relief  at  the  front. 

Gathered  at  San  Giorgio  di  Nogaro,   in  fraternal 


36  MODERN  ITALIAN  SURGERY 

reunion,  in  their  familiar  schools,  which  otherwise 
they  would  have  been  obliged  to  abandon,  the  pupils 
realized  the  importance  of  tuition  not  only  for  their 
immediate  benefit  but  also  as  an  advantage  to  their 
future  careers  and,  prompted  by  emulation  and  competi- 
tion, made  a  success  of  that  rather  original  experiment. 


Chapter  V 

MEDICAL  ORGANIZATION  AND  EFFICIENCY 
DURING  THE  WAR 

THE  Sanitary  Organization  of  the  Army,  which 
started  under  serious  difficulties  in  the  begin- 
ning, gradually  improved,  and  the  initial  de- 
ficiency, which  had  been  experienced  also  by  all 
the  other  nations  at  the  sudden  call  into  service,  was 
soon  overcome. 

Within  a  few  weeks  of  the  declaration  of  war,  every- 
thing was  ready,  from  the  first  place  of  attendance  at 
the  front  to  the  last  territorial  hospital  in  Italy. 

This  was  particularly  due  to  the  immediate  and 
opportune  fusion  and  cooperation  of  the  civil  and  mili- 
tary authorities,  which  became  a  powerful  means  of 
fighting  and  preventing,  from  the  very  beginning,  the 
various  and  terrible  epidemics  that  brought  such  mor- 
tality amid  the  enemies'  camps,  avoiding  a  disastrous 
panic  among  the  people  whose  endurance  was  already 
severely  taxed  from  so  many  other  sources. 

It  can  be  said  with  justice  that  war  surgery  in  Italy 
rapidly  developed  so  great  a  degree  of  efficiency  that  the 
wounded  men  had  the  most  complete  and  the  latest 
modern  treatment  skillfully  applied  at  the  front  as  well 
as  at  the  last  institution  prepared  for  that  purpose. 

The  national  mobilization  of  the  Medical  Corps  was 
accomplished  with  the  greatest  care.  The  best  men 
among  the  most  experienced  surgeons  were  selected, 

37 


38  MODERN  ITALIAN  SURGERY 

according  to  their  age  and  their  physical  condition, 
to  occupy  the  advanced  or  the  rear  position  as  chief 
surgeons  to  each  section. 

An  institution  belonging  entirely  to  modern  warfare 
was  soon  adopted  in  the  movable  hospitals,  which  were 
fitted  according  to  the  modern  requirements  and  placed 
under  experienced  specialists,  well  assisted,  ready  to 
give  urgent,  immediate  care  especially  to  abdominal 
and  thoracic  wounds.  These  hospitals  could  be  rapidly 
mounted  and  dismounted  for  quick  transportation  to 
the  nearest  point  of  an  impending  action,  so  as  to  be 
ready  for  instant  and  close  attention  to  cases,  thereby 
saving  lives  threatened  by  grave  hemorrhage. 

At  the  Surgical  Congress  of  Bologna  (March,  191 7) 
Dr.  Calabrese  reported  36  cases  successfully  cured  by 
immediate  intervention,  and  Dr.  Baldo  Rossi  of  Milan 
told  of  47  cases  successfully  discharged  after  similar 
instant  operation  in  the  movable  hospital. 

To  these  reports  must  be  added  the  statistics  of 
Drs.  Bozzi,  Nigrisoli,  Bastianelli,  Saviozzi,  which  give 
undisputed  proof  of  the  value  of  these  movable  hos- 
pitals and  the  possibility  of  saving  life  in  so  many  cases 
which  otherwise  would  have  been  fatal. 

From  the  first  post  of  medication  at  the  front  (where 
a  mere  summary  work  can  be  done)  the  wounded  were 
moved  rapidly  to  the  different  sanitary  sections  in  the 
immediate  rear,  where  they  received  the  first  real  treat- 
ment, before  being  sent  to  the  camp  hospitals  a  few 
miles  behind.  Here  in  the  camp  hospitals,  the  real  work 
is  done  by  the  best  young  surgeons  who  have  accom- 
plished miracles  of  splendid  surgery  under  the  most 
trying  conditions,  as  can  be  learned  from  very  accurate 


MEDICAL  ORGANIZATION  AND  EFFICIENCY      39 

reports  published  by  the  head  surgeons,  like  the  one 
of  Dr.  Saviozzi,  and  another  of  Dr.  Gherardo  Forni.1 

The  various  medical  journals,  The  Surgical  Clinic, 
The  Polyclinic  oj  Rome,  The  Hospital  Review,  and  many 
others  have  given  accurate  accounts  of  original  work, 
and  have  published  a  great  many  articles  on  surgery 
during  the  war,  which  constitute  the  most  important 
collection  of  valuable  studies  on  war  surgery. 

In  the  little  field  hospitals  (Ospedali  da  Campo)  most 
of  the  urgent  surgery  has  to  be  done  according  to  the 
seriousness  of  the  injury  and  the  immediate  need  of 
intervention.  As  soon  as  possible,  these  cases  are  trans- 
ferred to  a  larger  hospital  to  complete  the  cure.  One 
of  these  institutions  is  the  Military  Hospital  of  Turin, 
built  in  1 91 2,  with  a  capacity  of  2,000  beds.  It  is  located 
in  one  of  the  healthiest  and  most  attractive  parts  of 
the  city,  was  constructed  according  to  the  most  modern 
plans  and  requirements  possible  and  furnished  with  every 
modern  appliance  that  science  and  experience  could 
suggest. 

With  the  purpose  of  further  intensifying  the  surgical 
assistance,  the  Minister  of  War,  in  April,  191 8,  created 
the  so-called  "Surgical  Groups,"  each  directed  by  an 
expert  chief,  assisted  by  two  surgeons  and  two  sanitary 
helpers,  kept  in  readiness  for  immediate  dispatch  where 
the  work  was  most  needed.  Such  groups  proved  to  be 
most  efficient,  according  to  the  reports  published  in 
their  Journal  oj  Military  Surgery.  Many  territorial  hos- 
pitals were  organized  with  astonishing  rapidity  all 
over  the  country,  and  every  country  physician,  as  well 

1  Surgery  in  a  Camp  Hospital  in  the  Second  Line — Clinical  Notes,  Obser- 
vations and  Operations  upon  5,200  Wounded. 


4o  MODERN  ITALIAN  SURGERY 

as  every  clinic,  public  or  private,  was  mobilized  and 
militarized. 

Each  hospital  was  supplied  with  a  radio-apparatus 
(some  with  the  ingenious  modification  of  Gen.  Luigi 
Ferrero  di  Cavallerleone). 

War  surgery  was  discussed  and  popularized  by  an 
abundant  and  valuable  literature  published  in  the 
Surgical  Weekly  and  in  magazines  which  reported  also 
a  synopsis  of  home  and  foreign  work. 

Italy  may  well  claim  the  birth  of  war  surgery,  for, 
unfortunately,  she  has  been  for  centuries  the  battle- 
field of  all  Europe,  and  many  of  the  remedies  used  today 
were  old  panaceas  of  the  Middle  Ages.  Prof.  Da  vide 
Giordano  in  his  book,  reviewing  the  old  systems,  points 
out  that  many  modern  discoveries  were  already 
practiced  in  ancient  wars.  He  mentions  three  great 
Italian  surgeons,  Palletta,  Monteggia  and  Rima,  who, 
in  the  wars  fought  between  the  years  1800  and  1820, 
were  already  recommending  the  continual  irrigation  of 
wounds  with  a  solution  of  1  per  cent  of  table  salt 
(hypertonic  solution  recommended  at  present  by 
Wright),  and  also  the  boiling  of  linen  waste  in  a  very 
weak  solution  of  soda  (the  present  alkaline  solution). 
Larghi  of  Vercelli,  as  early  as  1842,  published  his 
experience  in  cases  of  suppurating  wounds,  in  which  he 
had  marvellous  results  by  using  solutions  of  nitrate  of 
silver,  from  small  doses  to  the  pure  sticks,  according  to 
the  location,  character  and  condition  of  the  wound, 
exactly  as  it  was  advised  recently  by  Danysz.1 

The  same  thing  can  be  said  of  hypochloride,  which 
was  used  very  extensively,  during  the  middle  of  the 

1Acad.  roy.  d.  sc,  Par.,  January,  19 15. 


MEDICAL  ORGANIZATION  AND  EFFICIENCY      41 

last  century  by  Professor  Gallozzi  of  the  University  of 
Naples,  author  of  a  well-known  treatise  of  surgery  and 
by  Professor  Durante  at  the  polyclinic  of  Rome. 

The  wonderful  activity  of  the  Italian  military  sur- 
geons was  brought  before  the  public  at  the  Surgical 
Congress  of  Bologna  in  March,  191 7,  where  convened 
from  every  part  of  the  front  and  from  every  territorial 
zone  the  representatives  of  Italian  surgery.  Every 
topic,  subject  and  argument  were  discussed,  not  only 
from  the  standpoint  of  personal  experience,  but  also 
from  the  more  positive  point  of  statistical  reports  and 
references. 

Drs.  Bastianelli  and  Donati,  reported  the  successful 
immediate  treatment  of  deep  wounds  by  large  incisions 
and  the  excision  of  the  affected  tissues  with  successive 
suture  and  primary  healing. 

While  the  method  of  Carrel  was  extensively  used,  the 
special  solution  of  Dr.  Giannattasio  (hypochloride  of 
lime,  bicarbonate  of  sodium  and  boric  acid,  called 
Chlorosol)  was  largely  used  with  success. 

Dr.  Schiassi  of  Bologna  read  a  paper  on  a  "New 
Biological  Treatment  of  Acute  Surgical  Infection, 
Especially  in  War  Wounds,"  consisting  in  the  immersion 
of  the  injured  part  in  a  solution  of  8  NaCI,  0.30 
chloride  of  potash,  1  chloride  of  calcium,  1 .50  glucose, 
2  citrate  of  sodium,  0.50  hydrate  of  sodium,  pure,  in 
1,000  parts  of  water  at  a  temperature  between  38  and 
39°C 

In  the  unfortunate  cases  of  gas  gangrene,  Dr. 
Camera,  after  describing  minutely  the  pathogenesis 
and  the  mode  of  diffusion  of  the  infection,  reported  the 
cases    in    which    he   dissected    carefully    the   affected 


42  MODERN  ITALIAN  SURGERY 

muscles,  removing  the  suspicious  part  as  in  a  case  of 
a  tumor,  and  packing  with  oxygenated  water. 

Dr.  Alessandri  of  Rome  reported  extensively  on 
surgery  of  the  head,  and  Drs.  Bastianelli  of  Rome 
and  Morelli  of  Pavia,  both  read  some  very  interesting 
contributions  to  the  surgery  of  the  thorax,  illustrating 
their  cases  with  new  observations  and  new  methods 
of  treatment  worthy  of  the  highest  consideration. 
The  application  of  an  artificial  pneumothorax  in  the 
treatment  of  pulmonary  wounds  with  grave  hemorrhage 
was  described  with  statistics  by  Dr.  Morelli,  showing 
successful  results.  Dr.  Morelli's  method  was  soon  uni- 
versally adopted  as  the  most  rational  and  practical, 
because,  by  removing  the  blood  from  the  pleura 
immediately,  it  prevented  an  infection,  and  with  it  the 
subsequent  adhesions  and  impairment  of  the  lung 
functions.  Also  the  introduction  of  sterilized  air, 
compressing  the  wounded  lung,  arrested  the  hemor- 
rhage and  allowed  the  immobilized  lung  to  heal 
rapidly.  Dr.  Morelli  has  published  his  discovery  and 
method  of  treatment  in  book  form,  which  has  recently 
been  translated.1 

The  directors  of  the  movable  hospitals,  Drs.  Cala- 
brese,  Bozzi,  Rossi,  NigrisoIIi  and  Bastianelli  contributed 
largely  to  the  subject  of  abdominal  surgery,  reporting 
hundreds  of  operations,  of  which  they  told  in  detail  the 
complete  histories,  accompanied  by  valuable  comments 
and  conclusions. 

To  give  here  in  detail  the  work  of  that  memorable 
Congress  of  Bologna  held  in  the  most  critical  moment 

xThe  Treatment  of  Wounds  of  Lung  and  Pleura,  by  Eugenio  Morelli.  Trans- 
lated from  the  Italian  by  Lincoln  Davis  and  Frederick  Irving,  Boston,  1920. 


MEDICAL  ORGANIZATION  AND  EFFICIENCY      43 

of  the  war  would  be  too  stupendous  an  undertaking, 
but  the  benefits  which  resulted  from  the  reading  of 
so  many  valuable  papers,  and  from  the  broad  scientific 
discussions  which  followed  each  lecture  have  been 
remarkable.  A  good  many  new  methods  and  a  good 
many  modifications  of  old  methods  of  operation  and 
treatment  of  all  sorts  of  injuries  were  brought  to  light 
and  were  made  popular  among  many  young  and  alert 
physicians  and  surgeons,  who  took  advantage  of  that 
unique  opportunity  of  learning,  which  resulted  not  only 
in  the  personal  benefit  of  each  one,  but  also  in  the  benefit 
of  humanity  at  large  as  a  universal  advancement  in 
scientific  studies  and  researches  and  their  practical 
application. 


Chapter  VI 

ASSISTANCE  TO  INVALIDS  AND  THE  WORK 
OF  RECONSTRUCTION 

THE  matter  of  assistance  rendered  invalids  and 
the  reconstruction  of  those  mutilated  in  war 
deserve  special  mention  here,  and  I  wish  to 
pay  my  tribute  of  admiration  to  President 
Dr.  Francesco  Durante,  professor  of  the  surgical  clinic 
at  the  University  of  Rome,  and  to  Vice  President  Dr. 
Enrico  Burci,  professor  of  the  surgical  clinic  at  the  Insti- 
tute of  Florence. 

In  a  very  elaborate  volume,  published  by  "Unione 
Editrice"  of  Rome,  the  National  Federation  gives  a 
special  report  of  what  was  done  in  the  cities  of  Ancona, 
Bologna,  Florence,  Genoa,  Milan,  Naples,  Padua, 
Palermo,  Perugia,  Pisa,  Rome,  Rovigo,  Turin,  Udine, 
Venice,  Verona  and  Vicenza.  This  large  and  beautiful 
volume,  profusely  illustrated  with  pictures  of  the 
various  institutions,  which  were  expressly  built  or 
adapted  for  the  purpose,  from  suitable  buildings,  and 
the  setting  forth  of  the  different  methods  of  treatment, 
with  an  accurate  description  of  the  ingenious  devices 
and  apparatus  made  by  expert  mechanicians,  was  a 
credit  to  the  organizers  of  the  undertaking;  so  much 
more  creditable  because  the  idea  came  almost  entirely 
from  the  initiative  of  local  committees  under  the  direc- 
tion of  the  National  Federation. 

44 


THE  WORK  OF  RECONSTRUCTION  45 

Special  attention  was  given  to  the  description  of  the 
different  methods  of  prosthesis  and  the  careful  system 
adopted  for  the  gradual  application  of  the  proper  appa- 
ratus made  and  developed  for  the  relief  of  the  mutilated 
in  each  case. 

Prof.  Vittorio  Putti,  director  of  the  Rizzoli  Ortho- 
pedic Institute  in  Bologna,  who  served  as  a  colonel  in 
the  Medical  Corps  at  the  Italian  front,  first  at  the 
invitation  of  the  English  Government,  and  afterward  at 
the  special  invitation  of  the  International  Conference  on 
Rehabilitation  of  the  Disabled  (March  18  and  21,  191 9), 
delivered  in  London  and  in  New  York  several  lectures, 
in  which  he  explained  the  working  of  the  organization 
in  Italy,  and  the  systems  and  methods  used  generally 
by  the  Italian  surgeons  especially  appointed  for  that 
kind  of  work. 

In  an  illustrated  lecture  Professor  Putti  describes 
in  an  incisive  manner,  a  method  invented  by  an  Italian 
physician  twenty  years  back,  consisting  in  the  utilization 
of  the  power  of  the  muscles  of  amputated  limbs, 
to  create  movement  in  the  different  parts  of  the  pros- 
thetic appliances.  Dr.  George  David  Stewart,  the 
well-known  professor  of  the  surgical  clinic  at  Bellevue 
Hospital,  New  York,  successfully  applied  this  method 
in  2  cases,  and  it  is  to  be  hoped  that  his  example  will  be 
followed  by  others,  thus  popularizing  in  America  the 
practical  discovery  of  Dr.  Giuliano  Vanghetti  of 
Empoli  (Tuscany). 

With  the  kind  permission  of  Professor  Putti,  I  reprint 
his  two  lectures,  which  fully  explain  the  method  and  its 
applications. 


46  MODERN  ITALIAN  SURGERY 

NATIONAL  ORGANIZATION  OF  REHABILITATION  FOR 
THE  DISABLED  IN  ITALY1 

The  work  done  by  Italy  for  soldiers  crippled  in  battle  is  so 
vast  and  complex  that  it  will  be  a  difficult  task  to  give  briefly 
an  exact  idea  of  it.  Now  that  the  war  is  over,  it  may  seem  super- 
fluous to  refer  to  what  was  accomplished  during  a  period  which  we 
hope  may  never  again  be  repeated;  but  we  think  the  work  achieved 
should  be  divulged  because  it  can  serve  as  a  basis  and  outline  for 
that  more  extensive  and  lasting  work  which  is  expected  now  for 
the  betterment  of  industrial  cripples. 

We  have,  therefore,  enthusiastically  accepted  the  honorable 
invitation  of  the  American  Red  Cross  because  we  realize  that  in  no 
other  country  as  much  as  in  this  one,  where  the  enormous  in- 
dustrial development  brings  the  number  of  accidents  during  work 
to  a  formidable  sum,  can  the  knowledge  of  our  experience  be  more 
useful  and  beneficial.  The  United  States,  which  is  a  leader  of 
civilized  nations  in  the  matter  of  social  welfare,  taking  advantage 
of  the  example  of  European  countries  will  soon  discover  new  ways 
and  methods  to  succor  those  who  are  crippled  in  the  various 
branches  of  industry. 

From  the  beginning  of  the  year  19 15,  when  Italy  had  not  yet 
declared  war,  throughout  the  entire  country  the  grave  question 
of  the  assistance  of  the  disabled  was  discussed.  By  means  of 
publications,  lectures,  meetings,  the  public  was  kept  in  touch 
with  the  very  important  problem  and  convinced  of  the  necessity 
for  a  thorough  collaboration  toward  the  performance  of  the  high 
duty.  The  country  responded  with  unanimity  of  opinion,  and  before 
the  end  of  the  year,  committees  were  formed,  sufficient  funds 
had  been  collected  for  the  establishment  of  the  first  societies  for 
the  moral  and  material  reliet  of  the  war's  disabled.  In  Italy,  as  in 
many  other  countries,  the  development  of  these  organizations  for 
the  social  welfare  of  these  handicapped  men  is  all  due  to  the 
initiative  of  private  individuals. 

Before  the  war,  Italy  had  no  institution  whatsoever  which  could 
serve  as  an  example  for  future  work.  In  Milan,  alone,  there  existed 

1  Presented  at  the  International  Conference  on  Rehabilitation  of  the  Dis- 
abled, Section  xvi,  New  York,  March  18  to  March  21,  1919. 


Handicraft  School  for  War  Cripples  at  Milan. 


THE  WORK  OF  RECONSTRUCTION  47 

a  school  for  the  vocational  education  of  disabled  civilians,  which, 
however,  could  only  aid  a  very  limited  number  of  patients;  there 
were  not  lacking,  though,  men  experienced  in  this  regard,  to  whom 
we  owe  the  rational  and  practical  methods  adopted  from  the 
beginning  by  Italian  organizations.  In  order  that  the  committees 
in  the  various  regions  of  Italy  might  work  with  uniformity  of 
standards,  in  191 5,  at  Rome  there  was  founded  the  Federation  of 
Committees  for  the  Relief  of  the  Disabled,  and  to  this  organization 
goes  the  credit  of  intense  propaganda,  and  the  collection  of  huge 
funds. 

The  larger  cities  of  Italy  were  immediately  provided  with  insti- 
tutions especially  suited  to  the  cure  and  training,  both  functional 
and  vocational,  of  the  handicapped  men.  Among  these  the  principal 
ones  are  Milan,  Palermo,  Bologna,  Turin,  Florence,  and  Rome. 
Soon  this  example  was  followed  by  other  centers,  and  there  sprang 
up  schools  in  Genoa,  Pescia,  Naples,  Pisa,  Leghorn,  and  Venice. 
But  in  the  place  of  private  initiative  came  the  government's 
action. 

The  task  was  undertaken  on  the  one  hand  by  the  War  Depart- 
ment, and  on  the  other  by  the  National  Commission  for  the  Relief 
and  Protection  of  the  Disabled,  provided  for  by  the  law  of  March, 
191 7.  This  law  not  only  provides  for  the  technical  re-education, 
but  also  for  the  important  and  complex  problem  of  the  after-care 
and  social  assistance  of  the  individual,  whether  he  be  incapacitated 
by  injuries  or  disease. 

I  do  not  think  it  necessary  to  dwell  at  length  upon  the  description 
of  the  work  during  the  first  periods  of  medical  care. 

From  the  field  hospital  the  disabled  soldier  is  sent  to  the  base 
hospital,  especially  built  for  this  purpose.  The  selection  of  the 
hospital  is  made  according  to  the  custom  of  sending  the  injured 
man  nearest  his  native  town  or  his  family. 

There  are  exceptions  made  to  this  mode  of  selection  in  the  case 
of  the  so-called  ultra  disabled.  These  are  the  men  who,  on  account 
of  the  seriousness  and  quantity  of  injuries,  are  not  only  unable  to 
readapt  themselves  to  any  kind  of  profitable  labor,  but  cannot  even 
provide  for  themselves  the  necessities  of  life. 

Sent  on  to  Florence,  these  ultra  disabled  find  refuge  in  a  rich 


48  MODERN  ITALIAN  SURGERY 

and  sumptuous  villa,  in  the  thick  of  the  woods,  and  there  enjoy 
all  the  advantages  of  a  moderate  climate. 

In  the  base  hospitals  for  the  disabled,  the  cure  is  completed  by 
the  psychotherapic  and  orthopedic  treatment,  with  a  view  to 
reducing  to  a  minimum  the  effect  of  the  injury,  and  to  preparing 
the  stump  for  the  application  of  the  artificial  limb.  From  this 
moment  the  work  of  encouragement  of  the  disabled  begins,  with 
the  object  of  convincing  him  that  he  is  still  capable  of  profitable 
labor,  of  inducing  him  to  re-train,  of  entertaining  him,  and  diverting 
his  thoughts  from  his  injury.  A  few  of  the  halls  in  the  base  hospitals 
are  set  apart  for  this  purpose  and  turned  into  laboratories  and 
classes;  these  are  maintained  by  civilian  committees  which  take  an 
active  interest  in  the  work  of  technical  training  and  after-care. 
When  the  patient  is  pronounced  physically  cured,  he  is  given  one 
month's  leave  before  commencing  his  re-education.  This  period 
of  leave  has  been  found  advisable  not  only  to  give  the  patient  the 
liberty  to  return  to  his  family  and  friends,  if  he  so  desires,  but 
especially  to  give  the  temporary  artificial  limb  enough  time  to 
produce  on  the  stump  the  transformations  which  are  necessary 
for  the  fitting  of  the  final  appliance. 

As  to  this  method  which  has  been  followed  in  Italy,  with  regard 
to  the  construction  of  artificial  limbs,  I  will  not  now  go  into  details, 
because  this  subject  will  be  more  fully  treated  by  me  in  another 
report.  The  production  of  artificial  limbs,  which  was  at  first  in- 
sufficient as  to  quantity  and  poor  as  to  quality,  is  now  completely 
satisfactory.  The  really  remarkable  progress  made  by  Italy  in  this 
field  was  universally  recognized  at  the  London  exposition,  May, 
1918,  on  the  occasion  of  the  Interallied  Conference. 

Both  the  War  Department  and  the  National  Commission 
appointed  committees  composed  of  persons  competent  in  ortho- 
pedics, and  of  representatives  of  the  Association  of  the  Disabled, 
who  were  to  control  the  work  of  each  factory  for  the  construction 
of  artificial  limbs.  Recently  the  War  Department  has  adopted  a 
standard  type  of  appliance  for  use  in  the  case  of  amputated  inferior 
limbs,  which  has  not  yet  been  tested.  Two  central  commissions 
residing  in  Rome,  are  entrusted  with  the  problem  of  encouraging 
new  developments  in  the  construction  of  artificial  limbs,  by  examin- 
ing models  submitted,  by  organizing  contests,  etc. 


THE  WORK  OF  RECONSTRUCTION  49 

At  the  end  of  the  physical  and  orthopedic  treatment  the  disabled 
remains  in  the  school  for  vocational  training.  This  re-education  is 
not  compulsory  in  Italy,  but  the  law  commands  that  each  man, 
after  having  recuperated  physically,  pass  at  least  fifteen  days  in 
the  training  school.  This  provision  of  the  law  which  has  been  made 
by  the  government  upon  the  example  of  the  Bologna  School  for 
Vocational  Training,  allows  the  invalid,  perhaps  ill-disposed 
toward  this  re-education,  to  witness  its  good  effects,  and  results 
in  the  vocational  training  of  a  far  greater  number  of  men.  To  give 
an  idea  of  the  tendency  of  the  disabled  to  undertake  vocational 
education,  I  will  say  that  in  the  Bologna  School  60  per  cent  of  the 
handicapped  have  accepted  to  be  trained. 

These  schools,  although  founded  by  private  initiative  and 
local  committees,  are  under  the  control  of  the  War  Department  and 
the  National  Commission.  The  War  Department  since  19 14, 
has  appointed  a  special  inspector  in  the  person  of  Prof.  E.  Burci, 
president  of  the  Italian  Section  of  the  Interallied  Committee, 
whose  aim  it  is  to  combine  the  work  of  the  military  authorities 
with  that  of  the  local  committees  and  distribute  equally  the 
material  and  spiritual  assistance  to  the  handicapped.  The  National 
Commission  has  control  over  the  re-education  schools  through 
local  committees,  which  during  the  first  period  of  the  war  spon- 
taneously undertook  the  establishment  of  vocational  schools. 
It  is  a  fact  worthy  of  note,  that  there  exists  in  Italy  a  flourishing 
Association  of  Disabled  Soldiers  and  Sailors,  with  a  membership 
of  about  50,000,  which  acts  in  strict  unison  with  the  military 
authorities  and  with  the  National  Commission,  in  all  that  regards 
the  social  welfare  of  the  disabled. 

In  view  of  the  enormous  expense  entailed  in  the  adequate 
development  of  the  training  schools  the  government  has  granted 
the  Committees  a  daily  subsidy  for  each  disabled,  amounting  to 
3.50  It.  lire  for  the  indoor  patients,  and  2  It.  lire  for  the  outdoor 
patients,  for  a  stated  period  of  not  more  than  six  months.  In 
many  cases,  however,  this  period  of  time  is  much  too  short  for  a 
complete  training,  and  under  those  circumstances  the  local 
committees  provide  out  of  their  funds  the  amount  required  for 
the  maintenance  of  the  injured  during  his  entire  stay  at  the 

institution. 

4 


50  MODERN  ITALIAN  SURGERY 

The  Committees  generally  grant  a  small  daily  allowance  to 
their  pupils,  about  one  lire;  part  of  which  is  put  into  savings 
banks  and  given  to  the  disabled  when  he  leaves  the  institution. 
Various  committees,  besides,  furnish  the  handicapped  man  with 
the  tools  of  the  trade  for  which  he  has  been  trained. 

We,  in  Italy,  are  convinced  that  the  resident  system  is  greatly 
superior  to  the  non-resident  system,  and  we  have,  therefore,  put 
the  former  into  more  extensive  practice.  Experience  has  also 
taught  us  that  the  larger  institutions  are  more  efficient  than  the 
small  ones,  and  the  National  Commission  has,  therefore,  decided 
to  give  the  maximum  support  to  the  more  active  and  best-organized 
of  them. 

Our  disabled  generally  find  in  the  schools  the  training  they  re- 
quire. The  more  common  trades  taught  are:  shoemaking,  tailoring, 
saddlery,  carpentry,  mechanical  trades,  bookbinding,  etc.,  further- 
more, all  trades  indigenous  to  agricultural  districts,  as,  for  instance, 
basket-making,  cartwright,  and  cooper  trades,  etc.  Then  there 
are  also  the  commercial  courses:  bookkeeping,  typewriting,  draw- 
ing, telegraphy;  all  the  disabled  are  compelled,  besides,  to  attend 
elementary  courses  of  study  for  a  few  hours  each  day. 

In  dealing  with  the  disabled  man  in  the  choice  of  his  occupation, 
I  will  quote  the  conclusions  to  which  Mr.  Chevelley  has  arrived 
in  an  important  study  of  the  question  of  which  he  has  acquired  a 
vast  experience: 

i.  Whenever  it  is  possible,  the  disabled  men  ought  to  be  retained 
in  the  trade  followed  by  them  in  the  pre-war  days,  or  in  one  similar 
to  it. 

2.  The  above  rule  ought  to  be  applied  especially  to  agricultural 
laborers,  who  constitute  in  Italy  about  85  per  cent  of  the  total 
number  of  disabled  men. 

Through  the  efforts  that  have  lately  been  made  by  the  League 
of  Assistance  committees,  and  by  the  individual  committees  as 
well,  laborers  have  been  induced  to  return  to  the  land,  disabled 
men  having  become  convinced  of  the  advantages  accruing  to  them 
and  their  families  by  so  doing.  This  is  a  step,  however,  to  be 
taken  only  after  the  disabled  men  have  learned  the  use  of  labor 
appliances  suitable  to  each  particular  case,  and  on  their  completing 


THE  WORK  OF  RECONSTRUCTION  51 

a  course  wherein  they  have  been  taught  the  rudiments  of  modern 
agriculture;  in  this  way,  and  in  spite  of  their  physical  disability, 
they  may  obtain  from  the  land  a  much  better  yield  than  they 
would  have  done  had  they  persisted  in  following  the  ancient 

methods. 

3.  In  view  of  the  very  large  number  of  disabled  men  who  aim 
at  obtaining  small  government  appointments,  the  necessity  has 
been  recognized  of  discountenancing  their  applications,  and  by  so 
doing,  sparing  them  many  future  disappointments;  it  has  been  also 
recognized  that  it  is  infinitely  preferable  to  give  the  disabled  men 
a  thorough  training  in  appropriate  trades  and  callings  which, 
besides  being  of  a  more  profitable  and  independent  nature,  are 
also  not  quite  so  much  sought  after. 

4.  The  authorities  have  also  come  to  realize  the  necessity  of 
discouraging  the  tendency,  which  has  increased  to  big  proportions, 
of  crowding  into  the  cities.  This  has  been  obtained  by  persuading 
the  disabled  men  to  return  to  their  native  towns  or  villages  as 
much  as  possible. 

As  far  as  regards  the  agricultural  training,  which,  naturally  is 
of  so  great  importance  in  Italy,  in  spite  of  the  good  attempts  made 
here  and  there,  it  is  still  very  far  from  being  considered  with  that 
broadmindedness  and  seriousness  which  it  deserves.  Many  re- 
educational  schools  are  provided  with  specially  organized  de- 
partments for  agricultural  training;  as,  for  example,  Florence, 
Genoa,  Leghorn,  Modena,  Pisa,  Rome;  then  there  are  the 
agricultural  branches  in  the  professional  colleges,  which  as  a 
consequence  of  their  development  have  assumed  an  almost 
autonomous  management,  as,  for  instance,  the  schools  of  Milan, 
Palermo,  Pescia.  And  finally,  we  have  the  schools  exclusively 
dedicated  to  agricultural  training  of  handicapped  men,  as  in  the 
case  of  Ancona,  Lecce,  Perugia,  Voghera,  and  Turin.  However 
great  this  number  of  schools,  their  efficiency  is  very  poor  and  we 
are  still  very  far  from  obtaining  those  good  results  which  we  were 
somewhat  entitled  to  expect. 

The  problem  of  placing  the  re-educated  man  has  been  carefully 
studied  in  Italy.  To  take  the  place  of  the  local  committee's  action 
soon  came  the  National  Federation  of  Committees,  through  whose 


52  MODERN  ITALIAN  SURGERY 

influence  was  formed  the  central  employment  office  which  quickly 
gave  truly  remarkable  results. 

To  these  various  relief  organizations  later  came  the  aid  of  the 
National  Association  of  the  War's  Disabled  whose  constitution 
had  not  overlooked  the  great  essential  item,  i.e.,  the  employment 
of  its  members. 

The  action  of  the  government  for  the  solution  of  this  grave 
question  came  later  and  took  the  form  of  the  law  of  March  25, 
191 7,  of  which  I  have  made  mention,  and  which  indicates  to  the 
National  Commission  the  plan  to  be  followed  in  placing  the 
remade  man. 

According  to  the  new  law,  soldiers,  who  in  accordance  with  the 
existing  regulations  have  been  declared  disabled,  may,  when  their 
disability  allows,  remain  in  the  army  with  the  military  authorities' 
consent. 

With  regard  to  the  readmission  and  admission  into  public 
offices  and  works,  the  facilities  which  the  law  grants  may  be 
divided  into  three  categories :  the  right  to  readmission  to  the  offices, 
the  bestowal  of  posts  without  competition,  and  the  preference 
in  competition  where  talent  or  attainments  are  equal. 

Another  opportunity  granted  by  the  law  is  that  on  the  basis 
of  which  the  condition  of  being  a  disabled  man  constitutes  a 
right  to  precedence  in  the  case  of  equality  of  talent  and  qualifica- 
tions in  the  graduation  of  competitors  for  admission  to  public 
employment.  Facilities  of  general  character  have  also  been  granted 
both  by  law  and  regulations  which  are  intended  to  give  aid  to  the 
disabled  in  obtaining  employment  by  private  concerns  or 
individuals. 

In  the  concessions  of  posts  or  scholarships  not  destined  to  bene- 
fit any  designated  families,  preference  is  given  to  the  disabled  and 
on  the  same  terms  as  the  other  competitors,  to  their  children. 
As  far  as  is  applicable,  the  legal  privileges  obtained  for  war  orphans 
are  extended  to  the  children  of  the  disabled. 

It  is  finally  stated  that  all  accident  insurance,  taken  out  in 
connection  with  the  work  of  disabled,  re-employed  in  any  kind  of 
factory,  is  compulsorily  assumed  by  the  insurance  institutions, 
and  that  in  the  employment  of  the  disabled,  as  element  for  the 


THE  WORK  OF  RECONSTRUCTION  53 

valuation  of  the  risk,  this  would  become  necessary  only  if  their 
number  exceeds  a  certain  limit. 

As  regards  the  pensions,  I  can  only  give  you  here  a  very  short 
account  of  what  Italy  has  done.  This  matter  has  been  adequately 
treated,  from  all  points  of  view,  by  Major  Giuriati,  at  the 
Interallied  Conference  at  London  in  May  of  last  year. 

The  problem  of  the  distribution  of  pensions  is  now  entirely  in 
the  hands  of  a  department  especially  created  in  November,  19 17. 

According  to  the  regulations  that  formerly  existed,  the  different 
degrees  of  disablement  were  classified  in  three  separate  categories 
only;  such  an  arrangement  was  far  from  being  in  accord  with  the 
variety  and  extension  of  the  subject.  For  each  one  of  these  cate- 
gories, as  was  prescribed  in  the  past,  a  stated  amount  used  to  be 
contributed  as  indemnity;  such  an  amount  was  by  no  means  a 
just  or  proportionate  value,  and  as  a  result  either  the  soldier  or 
the  government  has  to  sustain  serious  financial  loss. 

According  to  the  former  regulations,  it  was  understood  that  the 
title  to  pensions  was  limited  to  the  men's  unfitness  for  military 
service.  This  has  been  substituted  for  the  larger  conception  of  the 
men's  greater  or  lesser  fitness  for  the  undertaking  of  lucrative 
labor. 

The  government's  intention  is  to  compensate  the  individual 
for  the  diminishing  of  his  powers  for  lucrative  work,  and  propor- 
tionately to  his  physical  disablement. 

Consequently  the  different  degrees  of  disablement  for  which 
pensions  are  now  given  have  been  subdivided  into  ten  categories 
instead  of  only  three  as  heretofore;  this  is  proving  a  much  easier 
arrangement,  and  infinitely  more  in  proportion  to  the  exigencies 
of  the  different  cases. 

According  to  the  first  eight  categories,  the  subject  is  entitled  to 
a  pension,  while  for  the  last  two  he  receives  a  temporary  allowance. 
The  former  refer  to  permanent  disablement  of  a  greater  degree, 
which  minimizes  the  working  power  of  the  individual.  The 
allowances  are  given  to  men  suffering  from  lesser  degrees  of  dis- 
ablement, which  cause  a  much  smaller,  if  any,  reduction  of  the 
individual's  earning  capacity. 

In  cases  referring  to  a  presumable  modification  or  aggravation 


54  MODERN  ITALIAN  SURGERY 

of  the  degree  of  disablement  in  so  far  as  they  may  affect  the  men's 
working  capacity,  the  decision  stating  the  amount  of  pension  to 
be  paid  can  be  twice  revised  within  the  period  of  five  years. 

The  current  regulations  tend  to  facilitate  in  every  way  possible 
all  the  proceedings,  which  have  been  greatly  simplified.  The  facts 
are  submitted  to  only  one  medical  board,  and  the  interested 
party  has  seven  days  allowed  him  to  consider  their  decision,  either 
favorably  or  the  reverse.  Should  he  refuse  to  accept  it,  the  matter 
is  referred  to  a  Commission  of  Appeal,  which  consists  of  one  of  the 
directors  of  the  Military  Board  of  Health,  of  two  army  and  two 
civilian  doctors,  one  of  the  latter  being  appointed  by  the  National 
Association  among  the  disabled  men,  the  other  by  the  Local  Com- 
mittee dependent  from  the  Ministry  of  Pensions  and  of  Military 
Assistance.  In  this  manner  both  the  interests  of  the  soldier  and 
of  the  government  are  safeguarded. 

A  further  modification  has  been  brought  with  regard  to  ascer- 
taining whether  or  not  the  injury  is  due  to  service  reasons.  This 
has  been  greatly  facilitated  by  the  acceptance,  as  evidence,  of  the 
declaration  of  one  of  the  hospital  directors  or  of  one  of  the  com- 
mandants of  the  regimental  depots. 

So  liberal  an  interpretation  has  now  been  given  to  the  con- 
ception of  service  reasons  that  the  very  fact  of  the  man  having 
been  on  duty  is  considered  sufficient,  and  this  has  been  of 
enormous  importance  with  respect  to  disablement  caused  by 
illness  (tuberculosis). 

The  maximum  rate  of  pensions  is  allowed  for  disablements 
included  in  the  first  category  (ioo  X  ioo).  As  for  the  disable- 
ments included  in  the  other  categories — from  the  second  to  the 
eighth  inclusive — they  are  calculated  proportionately  at  80,  75, 
70,  60,  50,  40,  and  30  per  cent  of  the  pensions  allowed  for  the 
first  category. 

Whenever  the  degree  and  nature  of  his  disablement  cause  the 
soldier  to  require  the  assistance  of  another  person,  he  is  entitled 
to  a  supplementary  allowance  over  and  above  his  pension. 

The  disablements  belonging  to  the  ninth  and  tenth  categories 
call  for  a  temporary  allowance,  instead  of  the  pension  for  life. 
This  allowance  is  equal  to  the  amount  of  the  pensions  belonging 


THE  WORK  OF  RECONSTRUCTION  55 

to  the  eighth  category,  payable  in  one  lump  sum,  and  calculated 
for  a  period  that  varies  from  a  minimum  of  six  months  to  a  maxi- 
mum of  six  years. 

I  must  say  a  few  words  before  terminating  on  the  assistance 
given  the  blind,  the  mutilated  in  the  face,  and  the  tuberculotics. 

The  Blind. — At  Milan,  Florence,  and  Rome,  concentration 
hospitals  for  the  blind  have  been  erected.  From  these  hospitals 
the  soldiers,  pronounced  completely  and  irreparably  blind,  are 
transferred  to  the  special  hospitals  or  schools  in  Florence,  Rome, 
Naples,  Milan,  Padua,  Catania,  according  to  the  locality  of 
their  birth,  for  their  re-education  or  after-care. 

The  work  of  the  re-educational  school  is  greatly  simplified  by 
a  disposition  of  law  which  provides  that  the  blind  soldier,  when 
still  in  the  concentration  hospitals,  be  given  a  practical  view  on 
his  new  life  and  a  methodical  sensorial  education. 

In  the  vocational  schools,  the  trades  most  frequently  taken  up 
are:  Cane  chairmaking,  brushmaking,  shoemaking,  bookbinding, 
wood  carving,  etc. 

The  choice  of  the  trade,  though  often  made  by  the  Council  of 
Directors  of  the  schools,  after  an  adequate  test  period,  is  left  free 
to  the  injured.  The  work  of  the  blind  is  generally  simplified  by  the 
use  of  special  apparatus. 

In  the  Vocational  School  at  Florence  much  experimenting  has 
been  done,  and  successfully,  with  training  the  blind  for  agricultural 
occupations.  At  Rome  the  wood  and  leather  trades  have  succeeded 
best.  The  more  cultured  blind  are  encouraged  to  become  masseurs, 
linguists,  musicians,  or  office  employees,  as  typists,  etc. 

From  the  employment  point  of  view,  Signora  Mandolfi,  who  has 
shown  an  intense  interest  in  this  end  of  the  work,  maintains  that 
the  blind  man  should  be  induced  to  take  up  individual  autonomous 
work,  whether  at  home,  in  the  factory,  in  the  office,  and  among 
persons  who  have  their  sight. 

Assistance  to  the  tuberculous  soldiers. — According  to  the  law 
dealing  with  the  assistance  to  the  disabled,  the  patients  suffering 
from  tuberculosis  are  considered  as  belonging  to  the  disabled  class, 
from  both  a  physical  and  practical  point  of  view.  The  question  of 
tuberculosis  has  been  sadly  aggravated  in  Italy  since  the  return 


56  MODERN  ITALIAN  SURGERY 

of  our  prisoners  of  war,  who  left  behind  them  in  the  cruel  Austrian 
concentration  camps,  their  health  and  youth,  coming  back  to  us 
only  too  often  inexorably  tainted  with  this  terrible  malady. 

The  antitubercular  fight  was  begun  by  the  Circular  No.  80 1, 
of  December  20,  19 16.  In  obedience  to  this  document,  in  every 
territorial  army  corps,  and  at  the  base  of  every  army  in  the  war 
zone,  special  sections  for  the  diagnostic  study  of  incipient  or  latent 
symptoms  of  this  malady  were  created. 

The  first  symptoms  having  been  discovered  in  time  at  these 
diagnostic  sections  that  are  under  the  management  of  specialists, 
the  patients  are  promptly  sent  away  from  the  ranks  of  the  army, 
and  benefit  by  a  whole  series  of  dispositions  and  provisions 
especially  drawn  up  with  a  view  to  receiving  them,  treating  them, 
and  giving  antitubercular  instruction. 

A  medical  center  for  the  selection  of  tuberculous  soldiers  was 
at  first  established  at  Nervi.  This  is  a  big  first-grade  institution  for 
the  gathering  together  of  the  numerous  tuberculous  patients  that 
have  been  returned  to  us  by  the  enemy,  where  the  diagnosis  is 
made,  and  the  degree  of  specific  lesion  ascertained  before  trans- 
ferring the  patients  to  other  hospitals  adapted  to  their  cases. 

Contemporaneously  with  the  institution  of  the  health  center  at 
Nervi,  which  can  accommodate  1,200  patients,  another  center  for 
selection  of  more  than  600  beds  was  set  up  in  the  rear  of  the 
war  zone  to  gather  together  and  select  the  patients  coming  from 
the  ranks  of  the  army. 

The  second  sanitary  center  for  selection,  organized  on  the  same 
lines  as  the  one  at  Nervi,  was  opened  at  Careggi,  a  locality  not  very 
far  from  Florence. 

By  both  these  said  centers,  as  in  all  the  other  diagnostic  sections 
belonging  to  the  various  army  corps,  the  patients  are  divided  into 
three  categories,  according  to  the  gravity  of  the  sickness. 

As  soon  as  the  condition  of  the  men  is  ascertained,  they  are 
received  in  special  tubercular  wards  at  the  different  hospitals 
where  these  same  wards  have  been  instituted  in  the  territories 
belonging  to  the  different  army  corps. 

The  patients  who  are  not  so  seriously  ill  are  sent  to  appropriate 
sanatoria  that  have  been  instituted  in  each  territorial  army  corps, 


THE  WORK  OF  RECONSTRUCTION  57 

where  they  are  kept  for  about  three  months,  and  where,  once  this 
period  passed,  they  are  given  their  discharge.  With  their  discharge, 
however,  the  assistance  given  to  this  class  of  disabled  men  does 
not  cease.  As  a  result  of  an  agreement  between  the  Ministers  of 
War  and  of  the  Interior,  all  these  patients  are  entitled  to  continue 
to  receive  all  possible  assistance,  both  medical  and  practical,  unless 
they  end  by  being  recognized  as  disabled  as  a  result  of  war  service 
and,  as  such,  entitled  to  all  their  pension  rights. 

The  military  administration  has  decided  to  grant,  instead  of  the 
bonus,  equal  to  a  year's  pension,  that  they  used  to  pay  now  and 
again  to  these  sick  men,  an  allowance  of  so  much  towards  their 
treatment  (assistance  allowance)  every  time  that  the  ex-soldier  has 
to  return  to  the  hospital  during  the  three  succeeding  years  after 
his  discharge. 

An  equal  sum  is  to  be  paid  to  each  patient  by  the  Ministry  of 
the  Interior,  so  as  to  total  a  daily  sum  equal  to  Lit.  5  per  diem. 

During  the  detention  of  the  discharged  soldier  in  the  sanatorium, 
the  respective  families  will  receive  a  daily  allowance  equal  to  the 
separation  allowance  given  to  the  families  of  the  soldiers  called  up 
for  military  service. 

With  regard  to  the  men  who  have  a  latent  form  of  tuberculosis, 
they  are  sent  to  special  sanatoria  for  treatment  of  initial  tuber- 
culosis (climatic  institutes)  generally  under  the  direction  of  the 
Red  Cross;  of  these,  there  are  already  three  of  some  importance: 
Bergeggi  near  Genoa,  Fara  Sabina  near  Rome,  and  Milanino  near 
Massa  Marittima;  the  patients  can  remain  in  these  institutions 
up  to  six  months  entirely  at  the  expense  of  the  military  adminis- 
tration. Once  this  period  of  treatment  is  over,  this  same  adminis- 
tration reserves  the  right  to  have  the  patients  re-examined  at  the 
diagnostic  sections,  where  it  had  been  decided  to  have  them  sent 
to  these  sanatoria,  and  where  further  decisions  as  to  the  care  of 
the  men  are  taken. 

In  the  help  of  tuberculotics,  the  government  and  Italian  Red 
Cross  have  been  materially  assisted  by  the  aid  of  the  American 
Red  Cross. 

From  the  very  first  months  of  the  war,  much  has  been  done  for 
the  aid  of  those  facially  mutilated  and  those  whose  nervous  systems 
have  been  seriously  impaired. 


58  MODERN  ITALIAN  SURGERY 

For  the  assistance  of  the  former,  concentration  hospitals  con- 
ducted by  specialists  were  erected  in  the  war  zone.  From  these, 
the  injured  are  sent  to  the  base  hospitals  where  all  possible 
aid  is  given  them,  not  excluding  prosthetic  applications.  In  this 
field  the  Italian  stomatologists  have  accomplished  a  truly  admir- 
able achievement.  The  prosthetic  appliances  are  furnished  by  the 
government  with  the  same  criteria  as  those  used  in  the  distribution 
of  artificial  limbs. 

Similar  organizations  have  been  instituted  for  those  suffering 
from  impairment  of  the  nervous  system. 

From  the  concentration  hospitals  they  are  sent  to  the  so-called 
neurological  centers  in  the  principal  cities.  Each  of  the  centers  is 
divided  into  two  sections:  One  for  the  patients  suffering  from 
organic  injuries,  the  other  for  those  displaying  neuropsychic 
phenomena. 

These  centers  are  under  the  supervision  of  the  local  committees 
for  moral  assistance,  technical  training,  and  re-employment;  the 
same  routine  is  followed  here  as  in  the  case  of  the  other  disabled. 

During  the  last  months,  there  have  been  instituted  at  Milan, 
with  funds  collected  from  public  charity,  two  hospitals  exclusively 
for  the  moral  aid  and  re-education  of  the  severely  injured  in  the 
spinal  cord  and  the  brain. 

I  have  given  but  a  pallid  idea  of  what  Italy  has  accomplished 
and  is  accomplishing  in  behalf  of  her  war  cripples.  Now  that  the 
war  is  over,  many  of  the  provisions  to  which  I  have  alluded 
have  been  somewhat  modified  and  must  naturally,  in  time,  under- 
go further  changes  in  accordance  with  the  new  requirements. 

But  the  foundation  which  the  nation  has  builded  so  fervently, 
enthusiastically,  and  wisely  will  remain  to  testify  before  all  the 
ages  to  the  magnificent  performance  of  this  high  duty,  and  serve 
as  a  basis  for  the  future  development  of  the  great  work  in  the 
interest  of  the  industrial  cripples. 


THE  WORK  OF  RECONSTRUCTION  59 

THE  UTILIZATION  OF  THE  MUSCLES  OF  A  STUMP  TO 

ACTUATE  ARTIFICIAL  LIMBS:  CINEMATIC 

AMPUTATIONS1 

It  affords  me  the  greatest  pleasure  to  place  before  the  British 
medical  profession  the  facts  as  to  what  has  been  called  cinematic 
amputation.  I  feel  this  all  the  more  because  I  am  thoroughly 
convinced  of  the  enormous  advance  which  the  conception  of 
cinematization  will  bring  about  in  the  treatment  of  disabled  men, 
and  believe  that  all  that  concerns  this  new  current  of  ideas,  as  well  as 
the  store  of  facts  related  to  them,  ought  to  be  placed  at  the  disposal 
of  the  world  at  large. 

In  briefly  reviewing  the  fundamental  theories  of  plastic  motors, 
and  pointing  out  the  vast  field  thus  thrown  open  to  the  activity 
of  orthopedic  surgeons  and  mechanical  engineers  through  the 
practical  application  of  these  theories,  I  venture  to  express  the 
hope  that  our  efforts  may  prove  welcome  to  all  those  who  have 
hitherto  had  no  opportunity  of  studying  this  important  scientific 
innovation. 

Whilst  in  Italy  the  tireless  work  of  propaganda  undertaken  by 
Dr.  Giuliano  Vanghetti,  the  original  exponent  of  these  theories, 
has  led  to  their  full  discussion  and  close  study  and  to  many  experi- 
ments, and  whilst  both  German  and  Austrian  scientists  have  been 
actively  working  to  obtain  the  most  practical  application  of  these 
same  theories,  the  medical  literature  of  France,  England,  and 
America  contains  very  few,  if  any,  allusions  to  the  subject. 

In  the  space  at  my  disposal  I  must  content  myself  with  outlining 
the  fundamental  principles  upon  which  the  theory  is  based, 
pointing  out,  as  briefly  as  possible,  the  various  ways  it  can  be  put 
into  actual  practice,  and  making  a  short  statement  as  to  the 
method  of  operation  and  the  results. 

The  possibility  of  utilizing  the  functional  resources  of  the 
stump  so  as  to  convey  movement  to  the  artificial  limb  was  an 
idea  that  came  to  Dr.  Vanghetti  first  in  1896,  at  the  time  of 
Italy's  second  expedition  into  Abyssinia,  when  soldiers  who  had 
been  taken  prisoners  by  the  native  forces  under  the  Negus  were 
cruelly  tortured  and  mutilated. 

1  Address  by  Professor  Putti  before  the  Royal  Society  of  Medicine,  London, 
March,  1919. 


60  MODERN  ITALIAN  SURGERY 

From  that  time  onwards  Dr.  Vanghetti  wrote  and  published 
innumerable  articles,  wherein  he  developed  his  theory  on  what  he 
had  now  named  "cinematic  amputation."  In  them  he  described 
very  fully  the  origin  of  his  idea  and  the  various  methods  by  which 
it  could  be  practically  applied.  Unfortunately  for  the  speedy  accept- 
ance of  this  most  novel  and  useful  idea,  Dr.  Vanghetti,  though 
his  originality,  cleverness,  and  ability  are  indisputable,  is  not 
a  surgeon,  but  a  physician,  and  for  this  reason  was  unable  to  put 
his  theory  into  practice.  He  was  therefore  forced  to  resign  himself 
to  endless  delays  before  he  succeeded  in  convincing  surgeons  of 
the  great  value  and  practical  possibilities  of  his  theory  and  obtain- 
ing their  cooperation,  which  was  indispensable  to  any  adequate 
test.  This  was  the  principal  reason  why,  prior  to  the  war,  the  cases 
of  cinematic  amputations  did  not  number  more  than  twenty. 

THE   PRINCIPLES   OF    CINEMATIZATION   AND   OF    "  PLASTIC   MOTORS " 

Dr.  Vanghetti  has  given  the  name  of  "cinematic  plastics" 
or  "cineplastics"  to  any  kind  of  bloodless  or  operative  plastics 
that  tends  to  economize,  restore,  or  substitute  those  muscular 
masses  that  can  be  employed  to  impart  direct  and  voluntary 
movement  to  an  artificial  limb. 

The  word  "cinematization"  was  formerly  used  to  indicate  the 
cineplastic  operation;  it  was  subsequently  applied  to  every  kind 
of  cinematic  artificial  limb,  and  finally  to  the  active  and  early 
mobilization  of  muscles  involved  in  cineplastic  operation. 

Every  moving  entity  obtained  cineplastically,  whether  blood- 
Iessly  or  operatively,  is  called  a  "plastic  motor." 

Plastic  motors  are  based  on  the  following  general  principle:  In 
an  amputation  or  disarticulation,  actual  or  antecedent,  the  tendon 
and  muscle,  provided  they  have  the  necessary  physiological 
protection — skin,  vessels,  nerves,  etc. — can  generally  be  used  in 
cinematic  prosthesis,  on  condition  that  the  formation  of  an  arti- 
ficial point  of  attachment,  to  be  protected  in  a  similar  manner,  is 
available.  Cinematization  can  be  effected,  or  prepared,  at  the  time 
that  the  primary  amputation  is  made;  it  can  also  be  done  on  stumps 
that  have  already  healed. 

Plastic  motors  may  vary  as  to  their  number,  position,  shape, 
and  function. 


THE  WORK  OF  RECONSTRUCTION  61 

Without  entering  into  too  detailed  a  description  of  the  numerous 
varieties  of  plastic  motors,  I  will  limit  myself  to  stating  that,  at  the 
present  day,  the  most  elementary  and,  up  to  now,  the  most 
commonly  used  are,  as  regards  shape,  the  clava  (clavus,  a  peg) 
and  ansa  (a  loop)  motors,  and  those  obtained  by  means  of  the 
canalizing,  or  tunnelling,  of  the  muscular  masses. 

As  regards  number,  the  motor  may  be  single,  double,  or  multiple; 
in  function  it  can  be  either  unimotor  or  plurimotor. 

When  the  motor  is  made  to  execute  two  opposite  movements  in 
succession,  it  is  called  alternative. 

According  to  the  position  they  occupy,  motors  are  either  terminal, 
when  placed  at  the  extremity  of  the  stump,  or  extraterminalt 
should  they  be  placed  in  the  continuity  of  the  stump. 

Down  to  the  present  time  the  upper  limb  has  been  more  fre- 
quently cinematized  than  the  lower,  but  the  number  of  successful 
cases  of  cinematization  of  the  lower  limbs  is  daily  increasing. 

APPLICATION   OF   THE   PRINCIPLES 

From  what  I  have  said,  it  will  be  evident  that  the  application 
of  cinematization  entails  essentially  a  radical  upheaval  of  all 
preconceived  notions  as  to  the  ordinary  methods  of  amputation. 

Principles  observed  in  the  performance  of  amputations  according 
to  prosthetic  criteria  have  already  caused  a  revolution  in  modern 
surgery,  but  they  must  again  be  subjected  to  modifications  in 
order  to  ensure  the  preservation  of  the  greatest  possible  amount  of 
the  original  bone  and  of  the  residual  motor  masses  and  integu- 
ments, for  these  must  be  used  for  the  preparation  of  the  plastic 
motor. 

In  cases  where  it  is  practically  impossible  to  perform  primary 
cinematic  plastic  operations,  as,  for  instance,  at  the  first-aid 
dressing  stations  in  the  full  stress  of  battle,  the  surgeon  can,  at  any 
rate,  always  so  operate  as  to  prepare  the  ground  for  a  future 
cinematization  of  the  stump.  Skin  flaps,  muscular  insertions, 
various  bone  and  tendinous  fragments  and  segments  of  limb, 
which  would  seem  utterly  superfluous  under  ordinary  circum- 
stances for  the  preparation  of  ordinary  stumps,  must  be  recognized 
to  be  of  the  greatest  value  in  view  of  the  future  cineplastics. 


62  MODERN  ITALIAN  SURGERY 

In  order  to  prevent  the  possible  loss  of  these  elements  and  of 
these  materials  whilst  the  stump  is  undergoing  the  process  of 
healing,  it  is  advisable  to  take  certain  special  technical  precautions 
to  avoid  the  retraction  of  the  softer  tissues;  this  ought  to  be  done, 
however,  in  such  a  way  as  not  to  hinder  the  ordinary  dressing  of 
the  wound. 

When  the  inflammation  has  decreased,  and  further  complications 
are  no  longer  to  be  feared,  the  time  has  come  for  the  actual  cine- 
matization,  that  is  to  say,  for  the  preparation  of  the  plastic  motor 
or  motors.  A  plastic  motor,  in  order  to  fulfil  the  purpose  with  which 
it  is  made,  must  conform  to  the  following  requirements: 

i.  It  must  possess  every  requisite  for  withstanding  a  firm, 
resisting,  and  painless  grip,  and  also  a  traction  force  that,  in  not  a 
few  instances,  may  be  high. 

2.  It  must  be  provided  with  a  sufficient  amount  of  muscle  masses 
capable  of  functional  movement  to  guarantee  the  accomplishment 
of  the  task  that  will  be  demanded  of  them. 

The  primary  conditions  for  obtaining  the  first  requisites  are: 

i.  That  the  motors  be  covered  with  skin  in  perfect  condition, 
well  nourished,  and  possessing  a  normal  degree  of  sensibility. 

2.  That,  with  regard  to  its  shape  and  dimensions,  the  motor 
be  of  a  size  suitable  for  the  fastening  of  the  hooks,  rings,  and  rods, 
that  are  destined  to  transmit  the  functional  movement  to  the 
artificial  limb. 

THE   "CLAVA"   MOTOR 

The  movement  masses  must  be  sought  for,  and  obtained  from 
amongst  those  which  the  stump  still  possesses.  Such  masses  as 
from  their  anatomical  structure  and  physiological  disposition 
produce  broad,  strong,  and  dissociated  contractions,  are  the  best 
adapted  to  the  task.  In  the  choice  and  distribution  of  these  masses 
the  fundamental  principles  of  the  physiology  of  movement  must 
be  thoroughly  observed  and  respected. 

As  the  tendon  is  the  element  best  adapted  for  the  transmission 
of  muscular  contractions,  it  should  be  largely  employed  for  the 
formation  of  plastic  motors.  Should  the  tendon  be  missing,  the 
muscles  must  be  utilized  either  by  including  muscular  bundles 


THE  WORK  OF  RECONSTRUCTION  63 

within  the  terminal  motors,  or  by  tunnelling  the  muscular  masses 
in  order  to  obtain  the  extraterminal  motors. 

The  antagonistic  force,  indispensable  to  all  active  movement, 
must  be  provided  either  by  the  stump  itself  through  the  formation 
of  two  motors  with  elements  belonging  to  muscular  groups  of 
opposite  action,  or  by  the  artificial  limb  by  means  of  elastic  resis- 
tance in  the  opposite  sense  to  that  given  by  the  plastic  motor. 

With  a  view  to  gaining  both  space  and  integument  it  may  be 
advantageous  at  times  to  shorten  slightly  the  bone  or  bones  of  the 
stump,  and  to  excise  superfluous  muscular  masses.  This,  however, 
can  only  be  done  when  the  bone  is  sufficiently  long  to  allow  it. 

In  order  to  provide  such  material  as  may  be  missing  in  loco, 
recourse  may  be  had  to  the  numerous  methods  that  modern  plastic 
surgery  places  at  our  disposal,  as,  for  instance,  skin,  muscular, 
aponeurotic  or  osseous  transplantations.  Arthroplasties,  with  the 
interposition  of  an  aponeurotic  flap,  may  be  utilized  so  as  to  render 
mobile  those  stump  segments  which,  through  stiffness  and  anky- 
losis, have  become  unusable.  By  these  same  means  a  new  joint  can 
be  created  in  the  continuity  of  the  stump,  thus  giving  the  plastic 
motor  the  power  to  develop  a  leverage  action. 

The  cinematization  of  the  thigh  stump  enables  us  to  solve  one  of 
the  most  difficult  prosthetic  problems — that  of  gaining  active 
power  over  the  knee-joint.  With  the  ordinary  artificial  limbs  the 
knee  extension  is  obtained  either  by  means  of  springs  or  of  elastics, 
quite  independently  of  the  will  of  the  patient,  or  else  through 
straps  put  on  the  stretch  by  auxiliary  movements  of  the  trunk 
and  shoulder.  In  some  cases  we  have  carried  out  successful  experi- 
ments by  cinematization  of  the  quadriceps  femoris;  then  the 
stump  itself  can  control  the  voluntary  extensor  movement  of  the 
knee,  and  restrain  the  flexor  movement. 

As  a  result  of  cinematic  plastics  we  are  now  able  to  utilize  certain 
stumps  which  hitherto  have  always  been  held  as  incapable  of 
functional  movement,  such  as,  for  instance,  carpal  stumps,  very 
short  stumps,  and  disarticulation  stumps. 

The  surgeon  who,  in  the  case  of  shoulder  disarticulation,  succeeds 
in  sparing  the  deltoid  and  pectoralis  major,  in  covering  these 
muscles  with  skin,  and  in  finding  means  of  creating  a  point  of 


64  MODERN  ITALIAN  SURGERY 

attachment,  may  be  congratulated  on  having  preserved  for  the 
benefit  of  the  mutilated  man  a  precious  functional  capital. 

With  regard  to  the  difficult  problem  of  utilizing  short  forearm 
or  short  leg  stumps,  the  solution  will  be  enormously  facilitated 
through  the  preparation  of  points  of  attachment  that  correspond 
to  the  insertion  of  the  biceps  and  patella  tendons. 


Fig.  i. — Forearm  stump.  Double  terminal  clava  motor,  f,  Flexor  tendons,  e, 

Extensor  tendons. 

(In  order  to  illustrate  the  fundamental  principles  of  cineplastics, 
Professor  Putti  demonstrated  a  number  of  plaster  casts  of  ampu- 
tated stumps,  in  which  he  had  prepared  different  kinds  of  plastic 
motors.  The  first  cast  was  of  the  stump  of  a  forearm  with  two 
terminal  motors  (Fig.  i);  one  of  these  had  been  formed  with  the 
tendons  of  the  flexor  muscles,  the  other  with  the  tendons  of  the 
extensor  muscles.  It  was  a  case  of  disarticulated  wrist,  and  the 
stump  was  already  completely  healed.  After  excising  about 
an  inch  and  a  half  of  the  radius  and  of  the  ulna,  two  cutaneous 
flaps  were  prepared,  each  of  which  served  to  cover  the  two  prin- 
cipal groups  of  tendons  in  the  forearm,  that  is  to  say,  the  flexor 
and  extensor  tendons.  Professor  Putti  thus  obtained  two  plastic 
motors  like  clumsy  fingers,  of  which  one  was  controlled  by  the 
flexor,  the  other  by  the  extensor  muscles.) 

Two  points  of  attachment  must  be  provided  in  these  two 
"fingers,"  in  such  a  way  as  to  ensure  the  transmission  of  their 
contractions  to  the  artificial  limb,  with  a  view  to  giving  movement 
to  the  hand.  This  I  obtained  by  means  of  metal  rings  covered  with 
vulcanized  rubber  placed  at  the  base  of  the  fingers,  and  gradually 
tightened  (Fig.  2);  to  them  the  artificial  motors  of  the  hand  were 
attached.  The  stump  thus  became  capable  of  giving  flexor  or  ex- 
tensor movements  to  the  artificial  hand. 


THE  WORK  OF  RECONSTRUCTION  6$ 

In  cases  in  which  it  is  not  possible  to  obtain  sufficient  material 
for  the  construction  of  two  motors,  we  must  limit  ourselves  to  the 
preparation  of  a  single  motor,  the  antagonistic  movement  being 
provided  in  the  artificial  limb  by  a  spring  or  an  elastic. 

THE    "ANSA"   MOTOR 

Another  type  of  plastic  motor  is  that  known  as  the  ansa  motor. 
In  the  case  from  which  the  cast  exhibited  was  taken,  after  shorten- 


Fig.  2.— Metal  ring  covered  with  rubber  for  clava  and  ansa  motors. 

ing  sufficiently  the  radius  and  the  ulna,  I  prepared  the  tendons  of 
the  flexor  and  extensor  muscles,  and  gathered  them  together  in 
such  a  way  as  to  form  a  ring  or  loop  (Fig.  3),  which  I  afterwards 
covered  with  skin.  Whenever  the  disabled  man  contracts  either 


Fig.  3. — Forearm  stump,  ansa  motor. 

of  the  two  muscular  groups,  this  ring,  or  loop,  displaces  itself 
alternately  either  in  a  flexor  or  in  an  extensor  sense,  and  the 
contractions  are  transmitted  to  the  artificial  limb. 
The  plastic  motors  so  far  described  are  formed  of  the  soft 


66  MODERN  ITALIAN  SURGERY 

parts  of  the  stump.  In  order  to  give  greater  consistency  to  the 
motors  they  can  be  provided  with  a  bony  support. 

ILLUSTRATIVE   CASES 

The  stump  in  the  first  case  demonstrated  is  from  a  case  of 
disarticulation  at  the  wrist.  I  formed  a  para-epiphyseal  pseudar- 
throsis,  excising  from  a  third  to  a  fourth  of  an  inch  of  bone  from  the 
shafts  of  the  radius  and  of  the  ulna  and  then  interposing  a  double 
flap  of  fascia  and  of  muscle  (Fig.  4).  I  was  thus  able  to  obtain  an 
artificial  wrist  having  all  the  movements  with  which,  normally,  the 
wrist  is  provided,  for  the  muscles  and  tendons  that  cause  these 
movements  had  been,  for  the  greater  part,  preserved. 

I  performed  a  similar  operation  on  the  stump  of  an  arm.  Having 
detached  a  fragment  of  bone  from  the  extremity  of  the  humerus 
at  the  height  of  about  one  inch,  I  interposed  a  muscular  flap 
between  the  severed  section  of  the  bone.  Thanks  to  the  neo-ar- 


Fig.  4. — Forearm  stump.  Artificial  wrist-joint. 

throsis,  the  stump  is  capable  of  flexor  and  extensor  movements,  for 
into  the  piece  of  severed  bone  the  muscular  bodies  of  the  biceps 
and  of  the  triceps  are  still  inserted  (Figs.  5,  6). 

I  believe  that  these  cases  sufficiently  show  the  principal  types 
of  terminal  motors.  As  regards  their  preparation,  it  is  nearly  always 
necessary,  as  I  have  said,  to  sacrifice  a  certain  quantity  of  the 
stump's  original  bone.  But  plastic  motors  can  be  obtained  without 
compromising  the  length  of  the  bone.  This  is  achieved  by  directly 
tunnelling  the  muscular  bodies. 

In  the  forearm  stump  I  prepared  the  group  of  the  flexor  super- 
ficialis,  preserving  its  normal  cutaneous  envelope.  By  a  plastic 
operation  I  next  covered  with  skin  the  space  comprised  between 
the  superficial  flexor  and  the  deep  flexor,  thus  creating  a  canal 


THE  WORK  OF  RECONSTRUCTION 


67 


completely  lined  with  skin  (Fig.  7).  During  the  period  that  the 
wound  was  healing  I  maintained  this  canal  open  constantly  by 
means  of  a  rubber  tube.  Once  the  cutaneous  wounds  had  healed,  I 
inserted  a  metal  rod  covered  with  vulcanized  rubber  in  place  of  the 


Fig.  5. — Arm  stump.  Clava 
motor  with  osteal  support 
(artificial  neo-arthrosis). 


Fig.  6. — Arm  stump,  same 
case  as  Fig.  5,  with  metal 
ring  in  place. 


rubber  tube.  This  little  rod  serves  as  point  of  attachment  for  the 
cords  used  to  convey  movement  to  the  artificial  hand  (Fig.  8). 
Following  each  contraction  of  the  flexor  muscles,  this  small  rod 
displaces  itself  in  a  proximal  sense,  and  thus  actuates  the  fingers 
of  the  hand. 


Fig.  7. — Forearm  stump.  Lateral  ansa  motor. 

Arm  and  thigh  stumps  are  better  adapted  to  this  style  of 
cinematization  than  are  those  of  the  forearm.  I  show  casts  of  two 
stumps  of  the  lower  third  of  the  thigh  in  which  I  prepared  a  canal 
running  horizontally  and  to  the  full  depth  of  the  quadriceps  a 


68 


MODERN  ITALIAN  SURGERY 


little  above  its  insertion  into  the  patella.  Into  the  canal  I  introduced 
a  skin  flap  folded  back  over  itself  in  such  a  way  that  the  cutaneous 
surface  was  turned  towards  the  lumen  of  the  canal.  The  tunnel 


Fig.  8. — Metal  rod  covered  with  vulcanized  rubber  in  use  with  tunnellized 

stumps. 

thus  formed  is  entirely  lined  with  skin,  and  can  withstand  without 
risk  of  damage  or  pain,  the  presence  of  the  metal  rod  that  serves 


Fig.  9. — Tunnelization  of  an  arm  stump  with  Sauerbruch's  method. 

for  the  transmission  of  the  extensor  movement  to  the  artificial 
leg  (Figs.  9,  10). 

At  the  first  glance  it  may  appear  strange  that  these  mechanical 


THE  WORK  OF  RECONSTRUCTION  69 

attachments  can  be  so  easily  tolerated.  Experience  has  proved, 
however,  that  if  the  plastic  motor  is  well  placed,  if  the  skin  that 
covers  it  is  healthy,  if  the  wounds  are  absolutely  healed,  neither 
the  rings  nor  the  rods  cause  the  slightest  harm.  When  the  clava 
motor  is  sufficiently  long,  and  its  head  is  large  enough,  the  ring 
surrounding  the  neck  of  the  clava  needs  not  be  tightened  to  such 
an  extent  as  to  interfere  with  the  blood  supply  of  the  motor. 


Fig.  10. — Tunnelization  of  a  thigh  stump. 

Moreover,  each  ring  is  provided  with  a  screw  by  means  of  which 
the  disabled  man  can  himself  regulate  the  pressure. 

The  disabled  men  get  so  accustomed  to  the  metal  rod  that  they 
leave  it  in  place  even  at  night.  The  rod  must,  however,  be  removed 
once  every  twenty-four  hours,  in  order  to  clean  it  with  alcohol  and 
oil  it  with  vaseline.  I  have  observed  that  the  skin  within  the  canals 
gradually  acquires  the  property  of  throwing  off  sebaceous  sub- 
stances in  greater  quantities  than  normal,  thus  providing  for  the 
oiling  of  the  canal. 

FUNCTIONAL  RESULTS 

Another  point  deserving  consideration  is  the  sensibility  of  the 
plastic  motors.  Professor  Amar  has  made  some  most  interesting 
physiological  researches,  showing  that  the  superficial  and  deep 
sensibility,  and  the  muscular  sense  of  the  stumps,  which  at  first — 
that  is,  shortly  after  the  amputation — are  greatly  altered,  not  only 


70  MODERN  ITALIAN  SURGERY 

recover  in  time,  but  eventually  attain  a  degree  of  sensibility 
superior  to  the  normal,  provided  the  stump  is  put  through  the 
proper  functional  training.  I  have  observed  that  the  same  thing 
happens  with  cinematized  stumps.  One  of  my  patients,  on  whom 
I  operated  over  a  year  ago,  is  now  able  to  note  with  considerable 
exactitude  the  difference  in  the  size  and  weight  of  the  articles 
which  he  seizes  with  his  artificial  hand. 

The  functional  results  that  can  be  obtained  from  a  plastic 
motor  depend  upon  numerous  factors,  but  especially  on  the 
cinematic  powers  of  the  muscular  masses  of  the  stump,  on  the 
manner  in  which  the  surgeon  has  found  it  possible  to  utilize  them, 
and  on  the  functional  use  the  motor  undergoes.  To  give  a  clear 
conception  of  the  amount  of  work  that  a  plastic  motor  can  do,  I 
may  state  that,  amongst  the  cases  operated  upon  by  me,  the  power 
of  the  motor  ranges  from  10  kg.-cm.  at  the  lowest  to  ioo  kg.-cm.  at 
the  highest.  For  a  motor  to  be  of  practical  use  it  must  be  contracted 
not  less  than  one  inch.  In  the  case  of  a  hip  stump,  I  have  obtained 
one  motor  that  contracted  to  the  extent  of  two  and  one-fifth 
inches,  lifting  a  weight  of  44  lbs. 

I  have  only  described  the  principal  types  of  plastic  motors. 
The  genius  and  the  ability  of  the  surgeons  will  find  here  a  vast 
field  of  action.  Naturally,  it  is  not  possible  to  treat  all  amputated 
stumps  in  this  manner.  Those  that  best  lend  themselves  to  it  are 
those  that  include  healthy  muscular  masses,  that  retain  normal 
innervation,  and  that  possess  an  ample  contractility.  Stumps,  with 
rigid  or  ankylosed  joints,  covered  over  by  skin  that  does  not  glide 
easily,  being  adherent  or  creased  by  a  scar,  do  not  supply  satis- 
factory plastic  motors.  The  age,  and  moral  and  intellectual  con- 
dition of  the  patient  are  also  important.  The  best  age  is  from  twenty 
to  thirty  years.  Disabled  men  of  insufficient  mental  development, 
or  those  who  are  not  likely  to  be  willing  to  follow  with  patience 
and  assiduity  the  necessary  functional  training  of  the  stump 
muscles,  ought  not  to  be  operated  upon. 

It  is  to  be  understood  that  cinematization  does  not  invariably 
require  operations  with  the  knife.  There  are  stumps  already  formed 
which  are  endowed  spontaneously  with  cinematic  resources  that, 
wisely  employed,  can  be  utilized  for  transmitting  movement  to 


THE  WORK  OF  RECONSTRUCTION  71 

the  artificial  limb.  I  will  content  myself  with  mentioning  the  wrist 
and  forearm  stumps,  in  which  rotary  movements  are  preserved, 
and  the  arm  and  forearm  stumps  which  possess  a  terminal  hood 
having  a  development  and  contractility  sufficient  to  ensure  a  good 

grip- 

CONSTRUCTION    OF    SUITABLE    ARTIFICIAL    LIMBS 

Whatever  type  of  plastic  motors  may  be  chosen,  it  is  an  essential 
condition  for  their  efficient  utilization  to  their  full  value  that  the 
artificial  limb  be  adapted  in  a  manner  suitable  to  their  power, 
their  number,  and  their  shape.  This  question  of  cinematic  pros- 
thesis is  so  vast  and  still  so  new  that  it  deserves  a  special  study  to 
itself.  It  is  now  undergoing  gradual  development  and  will  bring 
about  a  substantial  reform  in  ordinary  constructive  methods.  The 
surgeon,  the  physiologist,  and  the  mechanic  must  all  collaborate 
intimately  in  this  work,  as  only  by  means  of  the  perfect  fusion 
of  these  three  can  we  obtain  new  methods  of  a  really  scientific 
character  that  will  answer  modern  requirements  and  replace  the 
empirical  systems  which  have  been  followed  up  to  now  in  the 
manufacture  of  artificial  limbs. 

(Professor  Putti  demonstrated  specimens  of  artificial  limbs 
especially  constructed  for  cinematized  stumps.  Among  others, 
three  hands,  of  which  two  were  made  for  stumps  with  a  single 
plastic  motor:  in  one  the  contraction  of  the  motor  is  used  for 
opening  the  hand,  which  was  kept  closed  by  means  of  a  spring; 
in  the  other,  the  motor  closed  the  hand.  The  third  hand  was  made 
for  a  stump  with  a  double  motor;  the  movement  of  closing  and 
opening  the  fingers  was  wholly  controlled  by  the  two  motors. 
He  showed  also  appliances  representing  various  types  of  arti- 
ficial limbs  for  forearm  stumps,  and  continued  as  follows) : 

The  construction  of  the  artificial  limb  is  greatly  simplified  by  the 
possibility  of  utilizing  the  intrinsic  powers  of  the  stump.  The 
mechanical  contrivances  hitherto  used  for  moving  the  fingers 
are  most  elementary;  the  cords,  the  levers,  and  the  springs  used  for 
conveying  movement  to  the  hand  by  utilizing  the  movements  of 
the  elbow  and  of  the  shoulder  can  now  be  completely  done  away 
with,  and  the  disabled  man  rendered  able  to  open  or  close  the 


72  MODERN  ITALIAN  SURGERY 

fingers  in  any  position  of  the  limb.  Even  workmen's  tools  can  be 
used  in  a  practical  way  by  the  cinematized  stump,  and  a  special 
pincer  shaped  like  a  parrot's  beak  has  been  devised  for  the  use  of 
workers  in  metal. 

RESULTS 

As  to  the  ultimate  results  of  the  cineplastic  method,  no  final 
judgment  is  as  yet  possible,  for  though  the  idea  was  conceived  over 
twenty  years  ago,  cinematization  has  been  applied  on  a  larger 
scale  only  since  the  beginning  of  this  war. 

The  very  few  cases  of  operation  of  this  type  performed  prior 
to  the  war — almost  exclusively  by  Italian  surgeons — had  afforded 
sufficient  proof  of  the  soundness  of  methods,  but  they  had  not 
provided  enough  material  to  enable  us  to  judge  with  regard  to 
their  practical  usefulness.  Only  since  the  beginning  of  the  war, 
when  the  necessity  of  giving  practical  aid  to  the  vast  and  tragic 
army  of  disabled  men  came  to  the  fore,  were  our  surgeons  convinced 
of  the  expediency  of  testing  the  principles  and  methods  of  cinematic 
surgery.  We  are  yet  at  the  very  beginning  of  this  new  scientific 
movement,  and  the  surgeons  of  all  allied  nations  have  not  as  yet 
contributed  to  it. 

The  German  surgeons  have  followed  Sauerbruch's  example, 
and,  although  they  have  created  an  admirable  scientific  organi- 
zation, they  have  limited  themselves  to  the  repetition  of  a  single 
type  of  plastic  motor.  Consequently,  in  analysing  the  results 
obtained  by  them,  we  can  form  but  a  partial  judgment  of  the 
practical  value  of  cinematization.  The  number  of  operations 
performed  by  Italian  surgeons  is  probably  inferior  to  those  done  in 
Germany,  but  the  variety  of  the  motors  experimented  upon  by  us 
is  certainly  greater. 

It  is  easily  understood  that,  for  the  moment,  it  would  be  impos- 
sible to  make  a  synthesis  of  such  a  variety  of  facts.  I  therefore 
believe  that  it  will  prove  of  greater  benefit,  in  discussing  the 
results  that  have  been  obtained  through  cinematization,  to  con- 
sider the  question  solely  and  exclusively  from  the  point  of  view  of 
my  own  cases. 

These  number  about  fifty  examples  of  cinematization  of  the 


THE  WORK  OF  RECONSTRUCTION  73 

upper  and  lower  limbs,  either  primary  or  secondary;  plastic 
motors  of  various  types  were  formed,  and  in  each  case  an  artificial 
limb  was  applied.  The  functional  value  of  the  motors  was  studied 
by  dynamographic  and  dynamometric  methods,  whilst  their 
practical  capacity  was  tested  in  the  actual  use  of  the  artificial 
limb. 

At  the  Instituto  Rizzoli  I  have  at  my  disposal  a  large  workshop 
for  the  construction  of  artificial  limbs,  so  that  I  have  been  enabled 
to  study  cinematic  prosthesis  as  well;  this,  as  I  have  already  said, 
constitutes  one  of  the  most  important  sides  of  this  complex 
question. 

CONCLUSIONS 

The  researches  that  have  been  made  in  the  Institute  have 
brought  me  to  the  following  conclusions: 

1.  The  practical  results  that  have  been  obtained  through  cine- 
matization  have  convinced  me  that  the  hopes  aroused  by  the 
principles  and  methods  of  the  modern  theory  of  plastic  motors 
are  thoroughly  well  grounded.  Cinematic  plastics  are  entitled  to 
be  placed  amongst  the  most  brilliant  of  the  discoveries  of  ortho- 
pedic surgery,  deserve  to  be  accepted  with  perfect  confidence, 
and  to  be  tested  on  a  large  scale  by  all  those  whose  aim  it  is  to 
restore  to  the  disabled  man  his  functional  activity. 

2.  The  preparation  of  plastic  motors  is  a  well-defined  surgical 
act  that  must  be  performed  in  accordance  with  its  own  special 
methods,  which  have  already  stood  the  test  of  experience. 

3.  From  a  physiological  point  of  view  plastic  motors  have  been 
proved  capable  of  giving  both  the  quality  and  quantity  of  action 
of  which  the  muscular  masses  that  stimulate  the  said  motors  are 
capable.  Yet,  practically  considered,  plastic  motors  will  yield 
the  full  measure  of  their  value  only  if  the  artificial  limb  is  perfectly 
adapted  to  their  shape  and  their  strength. 

4.  As  the  principal  aim  of  cinematization  is  to  attain  the 
vitalization  of  the  artificial  limb,  it  is  essential  that  the  surgeon 
and  the  artificial  limb  maker  should  work  in  harmony,  in  order  to 
solve  satisfactorily  this  most  interesting  but  difficult  problem. 


Chapter  VII 

THE  CARE  OF  CRIPPLES  AND  ORTHO- 
PEDIC SURGERY  IN  ITALY 

THE  interest  of  the  Italian  public  in  the  misery 
of  cripples,   for  the  first  time  took  practical 
form  in  1839  by  the  foundation  of  an  orthopedic 
institute  in  Florence,  through  the  initiative  of 
Prof.  Ferdinando  Carbonai,  who  planned  and  managed 
it  entirely  on  the  lines  of  a  modern  institute  of  ortho- 
pedics, as  understood  at  that  early  time. 

Before  this  undertaking,  little  or  nothing  had  been 
done  in  Italy  for  the  unfortunate  beings,  beyond  their 
admission  to  hospitals  and  asylums  for  the  poor,  where 
they  were  merely  fed,  or,  in  rare  cases  of  deformities, 
treated  with  negative  results  in  public  hospitals. 

In  extenuation  of  this  lack  of  interest  of  the  Italian 
public  for  these  unfortunate  children,  mention  should 
be  made  here  of  the  foundation  of  "The  Seaside  Sani- 
tariums and  Mountain  Stations"  which  were  solely 
an  Italian  institution,  copied  afterward  by  all  other 
nations. 

The  original  idea  of  such  institutions  was  due  to  the 
propaganda  of  another  Florentine,  Dr.  Barellai,  who 
in  1853  succeeded  in  convincing  the  city  of  Florence 
of  the  high  value  of  such  a  project. 

At  first  a  small  number  of  children  were  sent  to  the 
seashore  without  special  arrangements  for  their  hous- 
ing; later  on,  a  sanitarium  for  over  100  children  was 

74 


Prof.  Alessandro  CodiviJIa,  Bologna. 


ORTHOPEDIC  SURGERY  IN  ITALY  75 

founded  in  Viareggio,  on  the  coast  of  Tuscany.  Soon 
after,  other  sanitariums  were  established  on  the  Riviera 
and  on  the  coast  of  the  Adriatic. 

At  present,  there  are  a  number  of  such  institutions, 
and  each  province  of  Italy  has  its  own,  where  children 
afflicted  with  rachitis,  tuberculosis  and  bone  deformities 
can  be  sent. 

The  great  advantage  of  such  treatment  was  so  highly 
appreciated  that  the  time  was  extended  and  plans  for 
transforming  these  sanitariums  into  permanent  hos- 
pitals are  under  consideration.  In  fact,  an  attempt  has 
already  been  made  in  the  case  of  the  seaside  hospital 
at  Palermo,  founded  by  the  late  Enrico  Albanese, 
surgeon  professor.  It  was  first  started  as  a  seaside 
sanitarium  in  1874,  and  later  turned  into  a  pediatric 
hospital  with  special  wards  for  orthopedic  surgery  and 
physical  treatment.  In  1880  it  accommodated  55  chil- 
dren. Lately,  it  has  been  enlarged  and  considerably 
improved.  At  present  the  surgical,  orthopedic,  kinesi- 
therapic  treatment  is  excellent,  due  to  the  hygienic 
conditions,  the  ocean  air,  the  climate,  the  sea  salt  and 
the  sun  baths,  which  give  the  best  possible  results  in 
rachitics  and  cripples  in  general. 

Returning  to  the  first  Orthopedic  Institute  of  Flor- 
ence, founded  by  Prof.  Ferdinando  Carbonai,  it  is  to  be 
noticed  that  it  was  modelled  on  the  plan  of  the  Pravaz 
Institute  of  Lyons.  Originally  it  was  built  for  30  patients. 
Later  on  it  was  enlarged,  treating  deformities  mainly 
with  gymnastics  and  hydrotherapic-kinesitherapic 
methods  and  resorting  at  times  to  tenotomies, 
myotomies,  gradual  redressments,  and  applications  of 
orthopedic  apparatus  made  in  the  institution. 


76  MODERN  ITALIAN  SURGERY 

The  result  from  this  hygienic,  medical  and  orthopedic 
method  of  treatment  was  so  excellent,  that  the  Institute, 
originally  built  for  well-to-do  classes,  became  later  on 
accessible  also  to  poorer  patients,  and  an  orthopedic 
clinic  was  opened  by  the  Tuscan  Government  for  the 
benefit  of  medical  students. 

The  patients  received  a  limited  elementary  instruc- 
tion— according  to  their  physical  capacity  and  endur- 
ance, and,  as  shown  by  the  Archives,  the  results  were 
excellent  up  to  the  close  of  the  institution  upon  the 
death  of  Professor  Carbonai  in  1888. 

Following  the  establishment  of  this  school  in  Flor- 
ence, another,  the  real  first  public  school  for  crippled 
children,  was  founded  in  1 872  in  Turin.  This  gave  shelter 
to  boys  excluded  from  the  public  schools.  It  was  founded 
by  Count  Riccardi  di  Netro,  who,  having  at  that  time 
charge  of  public  education  of  the  city,  had  the  oppor- 
tunity of  observing  that  the  unfortunate  cripples,  ex- 
cluded from  public  schools,  were  running  about  the 
streets  without  the  benefit  of  education  or  training  in 
some  kind  of  useful  handicraft. 

The  first  class  for  crippled  children  was  attended  by 
twenty-two  children  between  four  and  seven  years  of 
age.  From  among  the  applicants,  those  children  were 
selected  who  had  already  passed  through  the  period  of 
softening  of  the  skeleton  and  whose  bones  had  been 
consolidated.  The  children  received  sufficient  teaching 
in  that  class. 

Medically,  the  class  was  under  the  supervision  of 
Professor  Gamba,  who,  conscious  of  the  importance  of 
gymnastics  and  hygienic  care  and  surroundings  for 
crippled  children,  put  them  in  the  first  place  for  treat- 


ORTHOPEDIC  SURGERY  IN  ITALY  77 

merit,  so  that,  besides  an  invigorating  diet  and  tonics, 
electrotherapy  and  hydrotherapy  were  applied. 

The  favorable  results  of  this  first  experiment  led  to 
the  foundation  of  a  charity  union  to  further  develop 
and  improve  other  schools  of  the  same  type.  Within 
a  short  time,  four  more  schools  were  opened  in  the 
town  districts  mainly  populated  by  the  working  classes. 

From  the  reports  of  Professor  Gamba  to  the  Royal 
Medical  Society  of  Turin  we  learn  that  during  the  eleven 
years,  since  the  foundation  of  the  first  school  for 
crippled  children,  1,600  children  suffering  from  rickets 
had  been  treated  and  850  cured  or  sufficiently  im- 
proved so  as  to  be  able  to  attend  the  municipal 
schools  or  to  take  up  some  handicraft  or  trade.  From 
the  report1  it  can  be  seen  that  3,286  crippled  children 
were  treated.  The  majority  of  these,  on  leaving  the 
school,  were  able  to  earn  a  living,  that  is,  were  capable 
of  earning  their  daily  bread.  For  the  rest,  the  Chari- 
table Society  had  provided  in  some  other  way,  training 
them  for  such  handicraft  or  occupation  as  was  best 
adapted  to  their  individual  intelligence,  physical 
strength  or  inclination.2 

In  1886  a  branch  for  crippled  children  was  added  to 
the  school;  also  a  dispensary,  where  surgical  treatment 
was  given  to  special  cases  in  need  of  intervention  with- 
out charge.  An  average  of  100  crippled  children  attend- 
ed annually. 

At  present  the  conditions  are  much  improved  as  the 
Institute  has  three  new,  large  wards,  with  a  gymnasium, 

'Istituto   dei  Rachitici  di   Torino,  Assemblea    Generate   dei  Benefattori. 
Torino,  1892,  1897. 

2G.  Pini.  La  Scuola  dei  Rachitici  in  Italia.  Milano,  1848. 


78  MODERN  ITALIAN  SURGERY 

a  recreation  hall  and  a  garden,  sheltering  annually 
more  than  200  children  between  the  ages  of  four  and 
seven,  with  an  added  daily  attendance  of  about  130. 

The  children  are  brought  to  school  in  special  omni- 
buses which  pick  them  up  around  the  city  at  8  a.m. 
and  send  them  back  home  at  5  p.m.  They  are  fed 
twice  a  day  with  good  food,  and  in  some  cases  adminis- 
tered with  some  tonic  or  cod-liver  oil,  according  to 
medical  indication. 

The  children  are  given  a  bath  twice  a  week,  and  a 
specially  trained  teacher  instructs  them  in  proper 
gymnastic  exercises  under  the  supervision  of  a  physician, 
who  pays  daily  visits  to  the  different  sections.  At  the 
end  of  every  three  months  the  physician  records  the 
changes  in  the  general  condition  of  each  child,  regis- 
tering the  weight,  the  height  and  any  special  symptom 
worthy  of  notice. 

During  the  summer  the  children  are  taken  to  two 
country  homes  belonging  to  the  institution,  where  they 
can  live  in  the  open  air  amidst  favorable  hygienic 
surroundings,  and  by  the  end  of  August  a  selection 
is  made  of  those  dismissable  on  account  of  their  age 
or  because  they  are  cured,  improved  to  the  limit,  or 
incurable. 

Usually  these  children  attend  the  school  for  three 
years,  and  during  that  time,  if  necessary,  are  trans- 
ferred to  the  sick  ward  for  treatment. 

This  clinic  accepts  children  between  three  and  fifteen 
years  of  age  who  suffer  from  diseases  of  an  orthopedic 
nature.  Treatment  is  free  for  the  poor  of  Turin,  and 
the  other  patients  pay  from  20  to  80  lire  a  month.  This 
department  can  at  present  accommodate  50  patients. 


ORTHOPEDIC  SURGERY  IN  ITALY  79 

Three  hundred  patients  were  examined  in  the  dis- 
pensary during  the  first  year  of  its  existence,  and 
2,390  in  1907.  This  institute  for  crippled  children 
progresses  constantly  and  enjoys  the  greatest  sympathy 
of  the  population.  Two  pavilions  have  been  added  to 
the  buildings,  and  a  third  one  containing  plans  and 
installation  for  gymnastics  and  hydrotherapy  is  under 
construction. 

THE   INSTITUTION   FOR   CRIPPLES   AT   MILAN 

The  noble  initiative  of  Turin  was  followed  by  many 
other  Italian  cities,  the  first  being  Milan  in  1875, 
founded  at  the  suggestion  of  Dr.  G.  Pini1  on  the  same 
lines  as  the  school  at  Turin. 

According  to  Dr.  Pini  the  purpose  of  the  asylum 
was  to  bring  crippled  children  to  a  health  center  for  a 
few  hours  daily,  in  order  to  benefit  them  by  gymnastic 
exercises,  hydrotherapic  treatment  and  needed  medica- 
tions. He  planned  to  improve  their  physical  condition, 
and  at  the  same  time  teach  them,  in  practical  schools, 
such  subjects  as  would  be  of  importance  to  them  in 
their  future  life. 

The  first  endowment  fund  was  given  as  far  back  as 
1850  by  Marchese  Visconti,  for  the  construction  of  an 
orthopedic  hospital  for  crippled  children.  Later  on, 
a  well-equipped  ambulatory  and  clinic  was  founded  so 
as  properly  to  provide  for  the  increasing  attendance 
of  patients,  which  in  the  eight  years,  from  1875  t0  I883, 
reached  3,276.2 

Thus  originated  in  1874  the  "Istituto  dei  Rachitici" 

1  La  Scuola  e  gli  Istituti  dei  Rachitici  in  Italia.  Milano,  1848. 
*G.  Pini.  loc.  cit. 


80  MODERN  ITALIAN  SURGERY 

of  Milan,  founded  by  Dr.  Gaetano  Pini,  for  three 
special  purposes:  First,  to  prevent  the  spread  of  the  dis- 
ease, by  proper  advice,  better  food,  prophylactic  treat- 
ment, and  other  means  necessary  to  fight  the  causes  of  the 
disease;  second,  to  supply  medical  and  surgical  treat- 
ment to  combat  the  disease;  third,  to  establish  proper 
schools  for  the  alleviation  of  the  consequences  of  the 
disease. 

The  school,  the  ambulatory,  the  clinic  and  hospital 
were  built  originally  where  the  center  of  the  great 
institute  stands  at  present.  The  main  building  was 
erected  in  1881,  but  has  been  greatly  enlarged,  and 
special  wards,  operating  rooms,  halls  for  gymnastics 
and  hydrotherapy  are  in  full  working  order,  besides  an 
isolation  pavilion.  It  accepts  children  when  eighteen 
months  old,  at  a  stage  when  the  process  is  yet  active 
and  the  consolidation  of  bones  is  not  complete,  thus 
giving  more  opportunity  to  prevent  deformities.  This 
policy  made  it  necessary  to  enlarge  the  institution, 
under  the  guidance  of  the  late  Professor  Panzeri,  and 
later  on  by  Dr.  Galeazzi  the  present  director,  who 
improved  and  perfected  it,  according  to  the  latest 
scientific  requirements. 

About  100  non-paying  and  50  paying  patients  are 
admitted  in  the  new  wards,  which  are  provided  with  all 
the  necessary  apparatus  for  careful  examination  and 
thorough  cleansing  of  each  patient  before  admission. 

Furthermore,  the  establishment  was  provided  with  a 
new  operating  room,  a  chamber  for  electrotherapeutic 
diagnosis,  a  hall  for  hydrotherapy,  mechanotherapy, 
with  Herz's,  Zander's  and  Krukenberg's  apparatus,  a 
special  massage  room,  a  section  for  the  treatment  of 


u 


V 

o 


ORTHOPEDIC  SURGERY  IN  ITALY  81 

deformities  of  the  trunk,  most  of  the  work  being  done 
with  Schulthess'  apparatus.  A  department  for  physical 
education  is  also  attached.  It  is  further  provided  with 
scientific  laboratories,  radioscopic  cabinets,  rooms  for 
dissecting  and  for  histopathological  researches. 

Particular  attention  is  given  to  prophylaxis,  and 
early  cases  are  preferred  between  the  ages  of  two  and 
five  with  the  object  of  preventing  rachitic  deformities. 
Lately  a  working  department  has  been  added  for  edu- 
cating the  inmates  in  some  useful  calling  best  adapted 
to  their  individual  condition. 


THE  INSTITUTION  FOR  CRIPPLED  CHILDREN  AT 
GENOA 

Genoa,  also,  following  the  example  of  Turin  and 
Milan,  opened  a  school  for  crippled  children  in  1878. 
This  gradually  improved  until  at  present  a  new  building 
divided  into  three  pavilions  has  been  erected  in  an  attrac- 
tive location  whence  a  wonderful  view  of  the  gulf  can 
be  enjoyed.  It  is  particularly  intended  for  children  in 
need  of  prophylactic  and  corrective  treatment. 

In  Genoa  the  patients  have  the  great  advantage  of 
the  sea-bathing  cure,  combined,  since  1899,  with  that 
of  high  mountains  for  a  month,  and  the  sea  resort  for 
another,  with  satisfactory  results. 

Mantua  followed  Genoa  with  a  modest  institute  until 
1899.  Then  under  the  skillful  direction  of  two  well- 
known  physicians,  Dr.  Allessandrini  and  Dr.  Zoppi,  it 
began  to  develop  and  progress,  attaining  the  highest 
reputation.  The  institution  now  shelters  about  200 
children,  with  remarkable  hygienic  and  clinical  results. 


82  MODERN  ITALIAN  SURGERY 

THE  INSTITUTE  AT  CREMONA 

Cremona,  in  1881,  opened  an  institute  for  crippled 
children  consisting  of  a  school  and  ambulatory  clinic. 
Later  on,  it  was  annexed  to  the  Children's  Hospital, 
and  has  become  a  model  of  its  kind. 

THE  INSTITUTE  AT  BERGAMO 

Thanks  to  the  spirit,  the  energy  and  constancy  of 
the  present  director,  Dr.  Rota,  the  institute  at  Bergamo, 
founded  in  1884,  has  become  of  as  great  importance  as 
that  at  Milan,  of  which  it  is  an  imitation  so  far  as 
construction  and  equipment  are  concerned. 

The  school,  the  asylum  and  the  dispensary  were 
opened  first;  the  wards  were  added  in  1887  (three  years 
after). 

During  the  last  twenty  years  it  has  been  frequented 
by  1,445  crippled  children  for  treatment  and  training, 
and  the  ambulatory  clinic  examined  and  advised 
9,896  patients,  of  which  number  1,597  were  admitted 
to  the  ward  for  orthopedic  treatment  and  operations. 

Just  now  it  is  again  undergoing  great  alterations,  new 
buildings  are  being  erected  and  the  old  ones  enlarged. 
This  will  enable  it  to  admit  still  more  patients  and  to 
give  them  the  very  best  surgical  treatment.  The  site 
of  the  institute  could  not  have  been  located  in  more 
hygienic  and  attractive  surroundings. 

THE  INSTITUTE  AT  BRESCIA 

The  institute  for  crippled  children  at  Brescia  was 
planned  as  early  as  1882  but  for  economic  reasons  did 
not  materialize  until  1894.  But  since  then  it  has  been  a 
model  of  its  kind,  by  reason  of  its  schools,  dispensary 


ORTHOPEDIC  SURGERY  IN  ITALY  83 

for  gymnastics,  massage,  electrotherapy,  accurate  ex- 
aminations, operations  and  applications  of  apparatus 
for  correction  of  deformities.  The  results  have  been 
truly  remarkable,  about  one-third  of  the  children  be- 
ing annually  discharged  as  completely  cured  and  able, 
thereafter,  to  attend  public  schools. 

ORTHOPEDIC  INSTITUTE  AT  BOLOGNA 

Mention  has  been  made  before  of  the  "Tuscan 
Orthopedic  Institute"  founded  and  directed  by  Prof. 
Ferdinando  Carbonai  in  Florence,  in  1842.,1  which,  for 
lack  of  support,  practically  became  extinct  in  1888, 
with  the  founder's  death.  But  while  the  Tuscan  insti- 
tute was  dying  in  Florence  for  lack  of  support,  a  new 
one  was  founded  in  Bologna  through  the  generous 
donation  of  the  entire  fortune  of  Francesco  Rizzoli,  the 
famous  professor  of  the  surgical  clinic  at  the  University 
of  Bologna. 

In  accordance  with  the  wish  of  the  benefactor,  the 
institution  was  to  be  located  in  the  former  Monastery 
of  the  Olivetan  Monks,  on  the  hill  of  San  Michele  in 
Bosco,  overlooking  the  city.  Professor  Rizzoli  bought 
the  site  for  that  purpose  in  1880. 

The  institute  was  to  be  built  and  fitted  out,  so  that 
it  could  serve  the  following  noble  intentions:  First, 
the  advancement  of  science;  second,  the  benefit  to 
humanity;  third,  the  benefit  and  honor  to  the  country. 

An  old  historical  structure  was  chosen  for  the  realiza- 
tion of  Professor  Rizzoli's  widely  conceived  plans,  a 
large  famous  building,  which,  properly  restored,  would 

'Carbonai,  Cresci,  II  R.  Istituto  Ortopedico— Idroterapico  di  Firenze  e  Ie 
deformita  in  esso  curate. 


84  MODERN  ITALIAN  SURGERY 

serve  his  philanthropic  purpose,  and  be  preserved 
at  the  same  time  as  an  historical  monument.  It  required 
about  fifteen  years  to  complete  the  task,  at  the  expense 
of  1,400,000  lire,  for  the  restoration,  adaptation  and 
equipment  of  the  quarters  alone. 

It  was  due  to  the  favorable  conditions  of  the  old 
building,  and  the  excellent  talent  for  organization  of 
the  first  director,  Panzeri,  that  the  choice  of  this  beau- 
tiful cloister  was  satisfactory  in  every  respect.  One  gets 
the  impression  that  in  a  newly  erected  building,  such 
extravagantly  large  rooms  could  never  have  been 
provided. 

It  may  suffice  to  point  out  that  although  fitted  out 
for  only  150  beds,  it  occupies  an  area  of  13,150  sq.  m., 
the  greatest  part  consisting  of  wide  corridors  and 
splendid  halls,  where  the  patients  take  their  walking 
exercises. 

One  of  the  largest  halls  in  Italy — 162,26  m.  long — 
is  on  the  first  floor.  On  the  main  floor  there  is  a  hall 
250  m.  wide,  which,  in  winter,  can  be  closed  with  glass 
windows  and  doors  and  heated  so  that  the  patients  can 
walk  and  rest  in  it  unaffected  by  the  outside  temper- 
ature. 

In  the  other  quarters,  there  are  wards  and  rooms  for 
paying  patients,  and  for  the  cleansing  of  newcomers; 
halls  for  gymnastics  and  mechanotherapy,  for  hydro- 
therapy and  electrotherapy;  the  scientific  laboratories; 
the  library;  the  museum;  and  the  orthopedic  work 
shops. 

The  surgical  department  is  large  and  contains  several 
bandaging  rooms,  rooms  for  the  fitting  of  orthopedic 
apparatus  and  for  examinations.  Furthermore,  there 


Doorway  <»t  Kizzoli's  Orthope  lie  Institute;  Victor  Emanuel  in 
standing  beside  Prof.  Vittorio  Putti. 


ORTHOPEDIC  SURGERY  IN  ITALY  85 

are  the  dining  halls  for  the  patients  of  various  groups, 
conversation  and  reading  rooms,  library,  music  and 
billiard  rooms,  and  a  hall  for  skating. 

It  enjoys  a  wonderful  hygienic  situation.  Located  on 
a  hill  south  of  Bologna,  a  very  short  distance  from  the 
city,  it  offers  the  most  beautiful  view  over  the  city  and 
the  surrounding  hills  covered  with  rich  vegetation  and 
attractive  suburban  homes.  It  has  large  shady  gardens 
of  an  area  of  55,000  sq.  m.  on  the  slopes  and  on  the 
plains,  which  provide  recreation  for  the  patients.  It 
also  owns  a  dispensary  in  the  city,  where  applicants 
are  examined,  and  are  given  surgical  and  kinesithera- 
peutic  treatment. 

The  institute  possesses  appliances  for  treatment  of 
deformities  in  the  widest  sense  of  the  word:  First,  all 
the  hygienic  appliances  which  assist  in  the  treatment 
of  the  deformities  and  check  their  further  progress; 
second,  numerous  apparatus  for  therapeutic  purposes, 
forming  one  of  the  greatest  collections  of  modern 
appliances  of  that  kind,  making  possible  and  facilitat- 
ing the  treatment  of  all  sorts  of  deformities  and  diseases 
of  the  limbs. 

Aside  from  a  complete  outfit  of  Zander's  apparatus 
for  the  correction  of  deformities,  and  Schulthess'  outfit 
for  treatment  of  scoliosis,  the  institute  has  also  a  large 
number  of  other  valuable  appliances,  many  of  which 
are  manufactured  in  the  workshops  of  the  institute 
by  skillful  mechanics,  under  the  supervision  of  the 
physicians. 

In  this  way,  every  kind  of  hygienic,  gymnastic, 
compensatory  movement  is  supplied  so  that  anatomic 
deformities  and  functional  anomalies  can  be  treated 


86  MODERN  ITALIAN  SURGERY 

with  every  variety  of  modern  appliances  imaginable. 
The  best  machinery  for  hydrotherapy  and  electro- 
therapy has  been  installed,  and  any  new  device  can  be 
made  in  the  workshop.  The  equipment  of  scientific 
and  radiologic  laboratories  is  perfect,  continually  aug- 
mented with  new  discoveries. 

The  surgical  operations  are  performed  by  Prof. 
Vittorio  Putti,  assisted  by  two  chief  surgeons,  two 
permanent  assistants  and  a  number  of  volunteers, 
beside  a  number  of  post-graduate  students  who  regu- 
larly frequent  the  institute  for  special  training  in 
orthopedic  surgery. 

The  poor  patients  of  the  province  of  Bologna  are 
entitled  to  free  treatment  and  attendance.  They  occupy 
about  one-third  of  the  150  beds  of  the  hospital,  the 
rest  being  reserved  for  paying  patients.  A  large  number 
of  the  latter,  however,  pay  only  part  of  their  board. 

The  running  expenses  are  covered  partly  by  the 
income  from  the  endowment  of  1,700,000  lire,  left  by 
Professor  Rizzoli,  and  partly  by  the  contributions  from 
paying  patients.  The  expenses,  which  during  the  first 
years  (1897- 1899)  averaged  50,000  lire,  during  succes- 
sive years  reached  170,000  lire.  Up  to  1909,  3,600 
patients  were  treated  from  all  the  provinces  of  Italy, 
and  some  also  from  foreign  countries. 

The  charity  patients  furnish  the  amount  of  material 
for  teaching  purposes,  and  the  State  provides  for  the 
support  of  the  University  Clinic,  securing  the  patients 
from  the  other  hospitals  and  all  the  material  necessary 
for  instruction  of  the  students. 

A  prize  of  3,500  lire  has  been  donated  by  the  province 
in  honor  of  the  late  King  Umberto.  This  international 


Prof.  Vittorio  Putti,  Bologna. 


ORTHOPEDIC  SURGERY  IN  ITALY  87 

prize  is  awarded  every  fifth  year  for  the  best  paper  on 
or  invention  in  orthopedics. 

In  1905  the  prize  was  given  to  Prof.  Oscar  Vulpius 
for  his  monograph  on  tendon  transplantation.  The 
members  of  the  institute  are  excluded  from  competi- 
tion, and  the  committee  for  awarding  the  prize  is 
selected  from  the  medical  faculties  of  the  country. 

ORTHOPEDIC    INSTITUTE   OF   NAPLES 

The  Orthopedic  Institute  of  Naples  was  founded  in 
1900,  with  the  endowment  of  the  late  Duchess  Ravas- 
chieri.  It  has:  (1)  A  dispensary  where  poor  cripples 
from  the  surrounding  country  are  examined  and  treated 
with  gymnastic  exercises,  massage  and  minor  operations, 
etc.  (2)  A  charity  ward  on  the  first  floor,  consisting 
of  four  large,  well-equipped  rooms  for  children  and 
adults  of  both  sexes.  (3)  A  ward  on  the  second  floor, 
for  paying  patients  of  the  second  class.  (4)  A  small 
isolated  ward  for  paying  patients  of  the  first  class. 

The  following  departments  are  available  for  treat- 
ment:  (1)    A  surgical   operating   room,   with    annex. 

(2)  A  kinesitherapy  hall  which  occupies  the  main 
part  of  the  building,  with  350  sq.  m.  of  area,  with 
appliances  for  active  and  passive  movements — Zander's, 
Knoke-Dressler's,  Beefy 's,  Lorenz's,  and  Stillman's. 
This  department  has  likewise  rooms  for  special  manual 
massage  given  by  the  physicians,  as  well  as  dressing 
rooms  and   suitable  apartments   for  the  attendants. 

(3)  A  hydrotherapy  department  with  two  large  bath 
rooms,  a  room  for  shower  baths  of  various  systems 
and  a  dressing  room.  (4)  Electrotherapy,  with  static, 


88  MODERN  ITALIAN  SURGERY 

galvanic,  faradic  currents,  electric  massage,  hydro- 
electric and  radiotherapeutic  baths,  occupies  another 
special  hall.  Scientific  laboratories  for  chemical,  macro- 
scopic and  microscopic  analysis,  and  for  radioscopy  and 
photography  occupy  other  rooms.  (6)  Finally  an  ortho- 
pedic workshop  is  connected  with  the  institute.  In 
July,  1906,  a  seaside  sanitarium  was  added  to  it,  located 
on  the  beautiful  beach  of  Bagnoli  nearby. 

The  quarters  of  the  sanitarium  are  splendidly  located, 
directly  on  the  ocean;  they  are  sunny,  well  ventilated, 
and  surrounded  by  a  very  attractive  park.  On  the  ground 
floor,  there  are  a  waiting  room  for  visitors,  sleeping 
quarters  for  the  boys,  and  rooms  for  examinations  and 
dressing.  The  second  floor  is  occupied  by  the  sleeping 
quarters  for  the  girls  and  for  the  nurses,  with  a  special 
class  room  and  large  parlor  for  the  latter. 

Of  late  years  the  institute  for  crippled  children  at 
Naples  has  been  greatly  improved  and  enlarged  and 
with  its  excellent  hygienic  conditions  gives  equally 
excellent  results. 

Schools  or  institutions  for  crippled  children  connected 
with  dispensaries,  but  without  special  wards,  exist  also 
in  many  other  cities  of  Italy,  but  although  the  results  of 
special  treatments  given  to  the  crippled  in  these  are 
favorable,  yet  mention  cannot  be  made  of  such  here, 
where  only  real  organized  institutes  are  reviewed. 

Some  of  the  institutes  for  crippled  children  mentioned 
above,  should  more  correctly  be  called  orthopedic, 
especially  that  of  Milan,  one  of  the  most  complete  of 
its  kind.  Yet  they  all  retain  the  name  of  "  Institutes  for 
Crippled  Children,"  perhaps  on  account  of  their  origin. 
Others,  however,  were  founded  originally  with  the  idea 


ORTHOPEDIC  SURGERY  IN  ITALY  89 

of  treating  not  only  rachitic  cases,  but  also  deformities 
in  the  broadest  sense  of  the  word. 

By  the  foundation  of  schools  for  crippled  children 
an  important  step  was  taken  for  the  future  of  young 
cripples  by  saving  them  from  physical  and  intellectual 
decay,  and  giving  them  the  opportunity  of  earning  a 
decent  living. 

Schools  for  the  professional  training  of  cripples,  under 
strict  individual  system,  according  to  intellectual  and 
physical  capacity,  as  adopted  in  Germany,  Denmark 
and  elsewhere,  have  not  yet  found  great  sympathy  in 
Italy. 

More  liberal  and  broader  ideas  were  favored,  and  as 
early  as  1877,  at  the  Congress  of  the  Italian  Medical 
Societies,  the  following  resolutions  were  adopted : 

The  Congress  requests  that  professional  schools  be  founded  for 
crippled  children  whose  deformities  cannot  be  corrected  in  these 
schools.  Those  children  should  be  taught  such  arts  or  crafts  as 
they  can  perform  without  the  exertion  which  would  further  imperil 
their  bony  structure  and  with  it  their  general  condition. 

A  further  warm  appeal  was  made  by  Professor  Codi- 
villa  in  1905,  advising  the  founding  of  such  schools 
as  were  already  working  favorably  in  Germany,  Austria, 
Denmark,  Sweden  and  Russia,  where  cripples  were 
trained  according  to  their  physical  possibilities  and 
intelligence,  which  might  be  directed  to  the  perform- 
ance of  work  adapted  to  individual  cases. 

At  the  same  time  a  report  was  presented  by  Professor 
Galeazzi  to  the  Fourth  International  Congress,  for 
private  and  public  treatment  of  such  patients  (Milan, 
May  23-27,  1906). 


po  MODERN  ITALIAN  SURGERY 

In  that  report  Professor  Galeazzi  appeals  to  the  state, 
county  and  town  authorities  and  to  all  charity  organi- 
zations as  well  as  insurance  companies  for  their  moral 
and  financial  support  of  schools  and  workshops  for 
cripples  and  the  injured. 

This  appeal  was  not  in  vain,  and  thanks  to  the  muni- 
ficence of  the  president  of  the  institute  for  cripples  in 
Milan,  Signor  Carmine,  the  first  workshop  for  crippled 
children  was  founded  and  was  joined  to  the  institute 
for  rachitics.  The  idea  of  combining  the  school  with 
the  institute  was  a  fortunate  one,  for  the  pupils  of  the 
school  can  profit  by  the  outfit  of  the  institute. 

Only  cripples,  and  patients  paralyzed  or  injured, 
whose  physical  and  intellectual  powers  will  enable 
them  to  profit  by  the  attendance  are  admitted.  They 
do  not  remain  in  the  school  after  their  training  is 
completed  except  in  case  of  those  who  are  able  and 
willing  to  devote  themselves  to  teaching.1 

In  the  neighbourhood  of  Milan,  an  asylum,  endowed 
by  Ottolenghi-Finzi  has  been  erected  for  cripples 
entirely  unable  to  work.  This  asylum  receives  those 
cripples  who,  on  leaving  school,  can  neither  find  an 
occupation  nor  return  to  their  families,  or  those  who 
through  sickness  or  accidents  are  unable  to  work.  It 
is  |  located  in  the  country,  where  the  inmates  can  be 
employed  in  farming  or  can  apply  themselves  to  some 
light  work  adapted  to  their  condition. 

The  women  do  all  the  menial  work — washing,  iron- 
ing, sewing  of  all  sorts;  help  to  make  orthopedic  corsets 

1  G.  Pini.  Le  Scuole  e  gli  Istituti  per  I  Rachitici  in  Italia.  Milano,  1873. — 
Carmine.  Le  scuole  e  le  case  di  Iavoro  per  gli  storpi  ed  i  mutilati,  Nuova 
Antologia  di  scienze  Iettere  ed  arti.  Maggio  e  Giugno,  1908,  16. 


ORTHOPEDIC  SURGERY  IN  ITALY  9i 

and  leather  goods;  while  the  men  do  tailoring,  shoe- 
making  and  mending,  when  necessary. 

The  practical  results  of  these  institutions  are  truly 
remarkable,  and  it  is  to  be  hoped  that  other  cities  of 
Italy  will  follow  the  example  of  Milan,  and  that  the 
state  and  other  public  authorities  will  normally  encour- 
age and  materially  support  them  in  their  endeavor 
to  alleviate  this  social  misery. 

Much  has  been  done  in  Italy  for  the  crippled  and 
deformed,  and  we  note  with  satisfaction  that  the  schools, 
the  workshops  and  the  entire  system  are  being  contin- 
ually perfected,  so  that  Italy  can  proudly  take  her 
place  among  the  most  civilized  countries  for  her  pro- 
gress and  advancement  in  this  line  of  philanthropy. 


Chapter  VIII 
MODERN  SURGERY  IN  ITALY 

MODERN  surgery  in  Italy,  as  in  other  coun- 
tries, is  not  considered  simply  a  gift  of  a 
skillful  artist,  endowed  with  a  good  knowl- 
edge of  anatomy.  The  real  surgeon,  today, 
must  have,  beside  skill  and  ability,  a  full  medical 
education,  good  training  in  physiology,  anatomy, 
biology,  and  in  general  and  special  pathology  before  he 
undertakes  the  practice  of  a  profession  so  full  of  respon- 
sibilities and  criticism. 

Excellent  operating  technique  cannot  alone  justify  a 
surgeon's  work,  which  has  to  be  supported  by  a  con- 
scientious diagnosis,  based  upon  all  the  positive  in- 
vestigations which  science  has  placed  at  his  disposal.  In 
a  few  words,  the  art,  skill,  and  daring  which  would 
have  made  the  reputation  of  a  surgeon  in  the  last  cen- 
tury, would  not  count  for  very  much  today. 

The  "Errores  Medicorum  Terra  Tegit"  would  no 
longer  justify  mistakes,  since  a  more  educated  public 
expects  from  the  man  of  science  an  accurate  diagnosis, 
a  correct  and  clear  technical  procedure,  and  a  positive 
prognosis  in  which  art  and  skill  play  very  little  part. 

In  Italy  surgery  has  made  rapid  progress  of  late, 
attracting  the  attention  of  the  outer  world  more  and 
more;  hence  it  was  with  surprise,  indeed,  after  the  high 
praises  paid  to  the  Italian  surgeons  by  most  of  the 
foreign   colleagues,    that   we   read   the   denunciatory 

92 


MODERN  SURGERY  IN  ITALY  93 

comments  of  one  of  them,  Sir  Rickman  John  Godlee, 
Bart.,  in  his  volume  on  Lord  Lister:1 

In  Italy  all  surgical  reform  was  slow  and  the  adoption  of  anti- 
septics was  belated.  Writing  in  1878,  Dr.  Giuseppe  Ruggi  of 
Bologna,  said:  "Italy  is  the  most  indifferent  of  all  nations,  and 
seems  as  if  she  neither  interested  herself  nor  wished  to  interest 
herself  in  this  method  of  treatment  which  has  been  estimated  so 
highly  by  the  great  surgical  leaders  of  Germany." 

He  mentions  seven  Italian  surgeons  as  the  only  rare  exceptions 
who  had  at  least  given  it  a  trial.  One  of  these,  Bottini  of  Pavia, 
who  was  highly  successful  amidst  disgustingly  insanitary  sur- 
roundings, speaks  in  1878  of  the  general  acceptance  in  other 
countries  after  some  systematic  opposition,  whilst  in  Italy,  he 
adds,  the  doctrine  "has  been  suffocated,  up  to  that  time,  by  the 
terrible  insidious  weapon,  apathy." 

Another  Italian  surgeon,  De  Vecchi  of  Turin,  in  the  same  year, 
urges  his  compatriots,  if  not  to  adopt,  at  least  to  experiment  with  a 
method  now  pronounced  to  be  good  by  the  mature  experience 
of  other  countries.2 

Far  away  in  the  South,  Albanese  of  Palermo  met  with  some 
success  in  his  wild  practice,  which,  owing  to  a  prevalence  of 
brigandage  and  the  thirst  for  vendetta,  was  like  military  surgery 
on  a  small  scale.  But  no  Italian  surgeon,  as  far  as  is  known, 
entered  in  the  same  way  into  Lister's  life,  either  by  personal 
intercourse  or  by  correspondence,  as  those  in  the  other  countries 
which  have  been  mentioned.  Italy,  therefore,  needs  no  further 
mention,  and  the  same  may  be  said  of  the  Iberian  peninsula. 

I  wish  to  repeat  and  point  out  that  this  volume  on 
Lister  by  Sir  Rickman  Godlee  was  published  in  the  year 
191 7,  when  the  Italian  surgeons  had  already  given 
good  account  of  themselves  in  the  war  and  many 
English   surgeons,  who   had   had   the  opportunity  of 

1  London,  19 17,  356. 

1  Doctor  P.  De  Vecchi,  Contribuzione  alio  studio  della  medicazione 
antisettica  del  Lister.    Torino,  Rouz  e  Fa  vale,  1878. 


94  MODERN  ITALIAN  SURGERY 

inspecting  the  splendid  organization  of  the  Army 
Medical  Corps  and  of  the  Italian  Red  Cross,  had 
expressed  themselves  in  the  highest  terms  of  admiration, 
not  only  on  account  of  the  indisputable  efficiency  of  the 
Italian  surgeons,  but  also  on  account  of  the  splendid 
organization  of  those  "disgustingly  insanitary  sur- 
roundings" which  he  mentions.  As  for  the  brigands  of 
Sicily,  they  have  proved  to  be  among  the  best  soldiers 
Italy  had  at  the  front. 

Sir  Rickman  Godlee,  in  his  book  accuses  the  Italian 
surgeons  of  apathy,  but  he  confesses  that  Lister 
had  to  leave  Glasgow,  and  successively  Edinburgh, 
coming  to  London,  before  his  own  English  colleagues 
would  adopt  his  systematic  method,  which  was  bitterly 
criticized  and  even  ridiculed  all  over  the  British  Isles. 
If  the  learned  writer  would  have  taken  the  trouble  to 
consult  the  voluminous  literature  on  the  subject, 
published  after  the  date  of  my  pamphlet  (1878),  he 
would  not  have  indulged  in  such  expressions  against  a 
respectable  body  of  professional  men,  as  the  Italian 
surgeons  are  and  have  been  for  a  great  many  years. 

But  to  return  to  the  purpose  of  this  work,  I  can  say 
that  Lister's  method  was  soon  adopted  in  all  Italian 
clinics,  and  successfully  in  some  of  the  hospitals  which 
were  so  "disgustingly  insanitary." 

Durante  in  Rome;  D'Antona  in  Naples;  Tricomi  and 
Parlavecchio  in  Palermo;  Clementi  in  Catania;  De 
Paoli  in  Perugia;  Novaro  in  Genoa;  Carle  in  Turin; 
Mangiagalli  and  Galeazzi  in  Milan;  Tansini  in  Pavia; 
Bassini  in  Padua;  Tusini  in  Parma;  Donati  in  Modena; 
Ruggi,  Nigrisoli,  Monari,  Calabrese,  Putti,  Poggi,  in 
Bologna — all  these  well-known  professors,  well-known 


MODERN  SURGERY  IN  ITALY  95 

surgeons,  highly  appreciated  contributors  to  surgical 
study  and  work,  adopted  the  Lister  method  at  first  and 
followed  all  the  modifications  and  improvements  which 
were  incorporated  afterward. 

Extensive  literary  contributions  on  this  great  work 
of  Italian  surgeons  have  appeared  in  many  foreign 
medical  journals  and  magazines  and  could  not  have 
escaped  an  impartial  observer  and  conscientious  student 
of  the  present  condition  of  surgical  progress.  But  Italy 
has  been  sadly  neglected,  and  her  share  in  the  world's 
efforts  toward  a  further  advancement  in  every  branch 
of  study  has  not  been  recognized,  nay,  has  been  almost 
ignored. 

Her  efficiency  during  the  war  could  not  be  the  effort 
of  the  moment;  it  must  have  been  the  result  of  a 
long  preparation,  of  study  and  work  of  many  years 
past,  when  the  Italian  school  of  surgery  began  to  under- 
stand the  importance  of  its  intimate  association  with 
the  school  of  medicine. 

Laboratory  experimental  work,  pathological  re- 
searches, and  differential  investigations  which  lead 
to  proper  and  correct  diagnoses  are  only  possible 
when  medical  and  surgical  clinics  work  together.  Italy 
has  been  fortunate  in  having,  during  the  second  half 
of  the  last  century,  some  of  the  most  learned  men  at 
the  head  of  her  medical  clinics — such  men  as  Guido 
Baccelli  of  Rome;  Enrico  de  Renzi  and  Antonio 
Caldarelli  of  Naples;  Edoardo  Maragliano  of  Genoa; 
Camillo  Bozzolo  of  Turin ;  Carlo  Forlanini  of  Pavia  with 
his  successor  Eugenio  Morelli;  Achille  de  Giovanni  of 
Padua;  Augusto  Murri  of  Bologna;  Pietro  Grocco  of 
Florence,  and  several  of  their  pupils  who  are  following 


96  MODERN  ITALIAN  SURGERY 

at  present  in  the  glorious  steps  of  their  masters.  The 
influence  which  those  great  teachers  had,  and  still  have, 
over  general  medical  and  surgical  research  has  been, 
and  is  yet,  remarkable. 

It  reminds  us  of  the  period  of  the  Renaissance  and 
of  the  large  advances  in  surgery  in  Italy  during  the 
latter  half  of  the  sixteenth  century.  Vesalius,  Falloppio, 
Ingrassia,  Fabricius,  Bottallo,  Maggi,  and  later,  Cesare 
Magati,  were  all  profound  students  of  the  human  body, 
and  deep  investigators  of  human  nature,  as  far  as  the 
times  permitted  them  to  be,  before  they  claimed 
surgical  supremacy. 

The  war  has  been  a  revelation  of  a  new  Italy  to  many 
foreign  nations,  but,  to  her  great  advantage,  she  has 
also  been  a  revelation  to  herself.  The  necessity  brought 
together  many  Italians  of  different  provinces,  heretofore 
unknown  to  each  other,  giving  them  a  chance  to  appre- 
ciate the  scientific  value  of  their  countrymen,  so  that 
in  their  own  minds  the  importance  of  their  home 
scientific  standard  of  medical  and  surgical  education 
was  greatly  raised. 


Chapter  IX 
PRACTICAL  SURGERY 

THE  fact  that  the  history  of  modern  surgery 
in  Italy  has  been  written  here  only  in  con- 
nection with  the  universities,  schools  and  clin- 
ics does  not  mean  that  surgery,  in  Italy,  is 
confined  only  to  such  bureaucratic  centers.  On  the 
contrary,  there  are  in  each  of  the  one  hundred  large 
and  small  cities  of  Italy  several  institutions  or  hospitals 
directed  by  some  of  the  best  pupils  of  the  universities* 
clinics,  who  did  not  follow  the  professorship  career,  but 
went  into  private  practice  and  eventually,  through 
their  professional  merits,  were  selected  to  head  the 
provincial,  municipal  or  private  institutions,  some  of 
which  are  well  worth  the  reputation  they  have  acquired 
as  first  class  scientific  centers. 

Some  of  these  institutions,  supported  by  old  endow- 
ments, private  contributions,  donations  from  provinces 
and  municipalities,  are  well  equipped  with  all  the 
modern  conveniences  for  up-to-date  treatment,  being 
furnished  with  pathological  laboratories,  radioscopic 
and  hydrotherapeutic  apparatus,  even  publishing  a 
monthly  report  (Archivio  di  Scienza  Ospedaliera)  which 
is  afterward  referred  to  in  the  general  National  Report  of 
the  Hospitals1. 

These  institutions  are  not  confined  only  to  big  cities 
like   Rome,   Turin,    Milan,    Bologna,   Genoa,   Venice, 

1  Atti  dell'associazione  Italiana  dei  Direttori  degli  Ospedali. 
7  97 


98  MODERN  ITALIAN  SURGERY 

Naples,  Florence,  Palermo,  Catania,  Padua,  Trento, 
Trieste,  but  are  also  found  in  smaller  ones  like  Mantova, 
Ferrara,  Modena,  Parma,  Brescia,  Casale,  Alessandria, 
Asti,  Savona,  Livorno,  Pisa,  Siena,  Perugia,  Foggia, 
Cosenza,  Macerata,  Bari,  Lecce,  Reggio,  Brindisi, 
Taranto,  and  in  many  others  provided  with  hospitals, 
where  thousands  of  operations  are  performed  daily  by 
skillful  surgeons  whose  fame  often  goes  beyond  national 
recognition. 

In  this  connection  we  would  mention  the  names  of: 
Giuliano  Vanghetti,  a  physician  (of  the  little  town  of 
Empoli)  of  whom  mention  is  made  at  length,  in  other 
parts  of  this  book,  about  his  important  work  on  cine- 
matic amputations ;  Flavio  Valerani,  director  of  the  hos- 
pital at  Casale,  a  little  town  in  the  north  of  Italy,  where 
he  distinguished  himself  for  his  original  work,  skillful 
surgery  and  abundant  contributions  to  surgical  litera- 
ture of  the  highest  scientific  value;  Giovanni  Fiorani, 
whose  reputation  was  beyond  national  boundary  for  his 
scientific  surgery  in  the  hospital  at  Bergamo.  One 
of  the  most  celebrated  surgeons  of  the  middle  of  last 
century,  B.  Larghi,  performed  the  most  daring  and 
wonderful  operations,  before  Lister's  method  made  it  safe 
to  tackle  almost  any  organ  of  the  body,  contributing  an 
extensive  literature  on  almost  every  subject  of  surgery, 
on  the  progress  of  science  and  technique.  Edoardo  Bassini 
wrote  his  excellent  work  on  surgical  anatomy,  and  his 
particular  study  of  the  inguinal  canal  in  the  modest 
dissecting  room  of  a  provincial  hospital,  leaving  his 
name  famous  for  a  special  method  of  operating  for 
inguinal  hernia.  Enrico  Bottini's  surgery  of  the  neck 
is  only  second  to  that  of  his  friend,  Kocher,  and  his 


MODERN  SURGERY  IN  ITALY  99 

statistics  on  thyroid  operations  equalled  those  of  his 
rival  in  that  particular  disease.  Porro,  Mangiagalli, 
Calderini,  Ruggi,  and  Bozzi  are  well  known  for  their 
original  operations  on  the  uterus  and  its  appendages, 
and  Farina  is  known  for  being  the  first  to  operate  upon  a 
wounded  heart.  No  foreign  surgeon  who  has  visited  Venice 
ignores  Dr.  Davide  Giordano,  director  of  the  Ospedale 
Maggiore,  author  of  a  large  compendium  on  "Italian 
Operative  Surgery,"  who  excels  among  the  surgeons  of 
Italy  of  today.  The  lovers  of  surgical  literature  must 
be  familiar  with  the  original  work  of  A.  Boari,  surgeon 
in  chief  of  the  hospital  at  Ancona,  who  devised  the  most 
clever  operation  on  the  ureters  and  invented  a  special 
anastomotic  button  (1899),  or  with  the  unique  case  of 
interilio-abdominal  disarticulation  by  Cacciopoli  (1894). 

The  list  would  be  too  long  to  review  the  many  other 
valuable  contributions  to  the  progress  of  surgery  by 
officially  unknown  surgeons,  who  modestly  work  in 
small  centers  with  the  only  incentive  of  personal 
ambition  and  pride. 

Beside  the  regular  surgical  clinical  sections,  there 
are  also  flourishing  several  scientific  and  practical 
centers  dealing  with  all  the  branches  of  special  regional 
surgery.  Very  active,  for  instance,  are  the  clinic  and 
special  sections  of  otorhinolaryngology,  under  the 
direction  of  Giuseppe  Gradenigo,  at  present  professor 
at  the  University  of  Naples;  of  Ignazio  Dionisio  at 
Turin;  of  Camillo  Poli  and  Giulio  Masini  at  Genoa;  of 
Gherardo  Ferreri  at  Rome;  and  of  Vittorio  Grazzi  at 
Pisa,  all  of  whom  contributed  largely  to  the  treatment 
of  special  diseases. 

Special  mention  must  be  made  of  Giuseppe  Graden- 


ioo  MODERN  ITALIAN  SURGERY 

igo's  recent  studies  on  psychophysiology  in  relation  to 
aviation.  He  inaugurated  in  Rome  the  "International 
Sanitary  Congress  for  Aviation." 

The  gynecologic  institutes  have  also  attracted  special 
attention,  thanks  to  the  activity  of  Senator  Luigi  Man- 
giagalli  of  Milan;  Ernesto  Pestalozza  of  Rome;  the 
late  Luigi  Bossi  of  Genoa;  of  Ersilio  Ferroni  of  Florence; 
Innocente  Clivio  of  Pavia  and  Giovanni  Miranda  of 
Naples. 

In  Turin,  the  Ospedale  Maria  Vittoria  has  an  able 
surgeon  in  Libero  Bergesio  who  specializes  in  gynecology, 
in  which  the  celebrated  surgeon,  Antonio  Carle,  has 
invaded  the  field  with  that  ability  which  characterizes 
his  great  work. 


Chapter  X 
UNIVERSITIES  IN  ITALY 

THE  university,  in  its  earliest  conception,  was 
a  scholastic  guild,  a  gathering  of  groups  of 
men,  anxious  to  learn,  around  other  men 
disposed  to  impart  to  them  their  personal 
knowledge  and  experience.  These  groups  of  independent 
teachers  and  pupils,  in  the  course  of  time,  were  obliged 
to  organize  for  mutual  protection  and  for  a  public 
legal  recognition  of  their  rights  and  of  their  duties. 
From  that  time,  universities  became  well-established 
organizations  placed  under  the  protection  of  the  laws 
and  under  special  rules  set  by  the  government  of  their 
own  countries. 

The  privilege  of  granting  rights  to  a  university  and  to 
establishing  certain  rules  under  which  the  institution 
should  be  administered,  was  assumed  by  emperors, 
kings,  popes,  princes,  the  exclusive  rulers  of  the  various 
countries  in  medieval  times.  The  first  institution  of 
that  kind  in  Italy  (and  perhaps  in  the  world)  dates 
from  the  ninth  century,  when  the  School  of  Salerno  is 
mentioned  as  the  first  center  of  medical  studies. 

It  is  not  the  purpose  of  this  work  to  review  the  history 
of  surgery  taught  in  the  various  universities  organized 
throughout  Italy  after  that  of  Salerno,  for  numerous 
writers  in  England,  Germany,  France  and  Italy  have 
amply  dealt  with  the  subject,  but  particular  mention 
should  be  made  of  Dr.  James  J.  Walsh  of  Fordham 
University,  New  York,  who  published  only  a  few  years 

IOI 


102  MODERN  ITALIAN  SURGERY 

ago  the  interesting  volume  "Old  Time  Makers  of 
Medicine"1;  and  of  two  of  the  most  prolific  writers  of 
Italy  on  that  subject  during  the  last  century — Dr. 
Salvatore  de  Renzi  of  Naples  in  his  "Storia  della 
Medicinain  Italia"  (Napoli,  1844)  m  five  volumes,  and 
Dr.  Francesco  Puccinotti  of  Urbino,  in  his  "Storia 
della  Medicina,"  also  in  five  volumes. 

Italy,  from  the  tenth  to  the  fifteenth  centuries,  was 
the  center  of  the  medical  studies  of  the  world,  and  that 
long  period  of  time  was  also  the  most  flourishing  for 
the  Italian  Universities  of  Bologna,  Reggio,  Modena, 
Vicenza,  Padua,  Naples,  Piacenza,  Vercelli,  Arezzo, 
Rome,  Perugia,  Treviso,  Pisa,  Florence,  Siena,  Lucca, 
Pavia,  Ferrara  and  Verona,  and  later  of  Turin,  Mon- 
dovi  and  Chieri. 

Lewis  Stephen  Pilcher,  the  eminent  surgeon  of  Brook- 
lyn, editor  of  Annals  0/  Surgery,  wrote  an  interesting 
article  "The  Mondino  Myth"  which  was  published  in 
the  Medical  Library  and  Historical  Journal.2  With  the 
kind  permission  of  the  author  I  give  some  extracts 
from  his  lecture,  which  describes  so  well  the  conditions 
of  the  medical  schools  of  that  time. 

To  a  physician  who  is  at  all  interested  in  the  history  of  the 
development  of  medicine,  the  old  Italian  universities  will  ever 
afford  a  most  interesting  field  of  study  and  regard.  The  heroic 
age  in  medicine  was  lived  beneath  Italian  skies. 

How  many  of  the  men  who  were  the  creators  of  medical  learning 
lived  in  Italian  cities?  In  Padua,  Vesalius,  Colombo,  and  Fabricius 
ab  Aquapendente  taught;  Harvey  studied;  and  Galileo,  after  he  had 
exchanged  Hippocrates  and  Galen  for  Euclid  and  Archimedes, 
carried  on  his  researches  into  the  constitution  of  the  Universe. 

1  Fordham  University  Press,  New  York,  191 1. 

2  December,  1906,  iv,  No.  4. 


UNIVERSITIES  IN  ITALY  103 

At  Pisa,  Cesalpino  taught  and  Galileo  studied.  At  Salernum, 
whose  school  of  medicine  was  cradled  in  the  cloister  of  the  monas- 
tery of  Monte  Cassino,  and  was  fostered  by  the  Normans  during 
their  rule  over  Southern  Italy  and  Sicily,  medical  learning  was 
developed  to  its  highest  degree,  and  achieved  its  greatest  reputation 
during  the  time  of  the  Crusades,  when  it  healed  the  wounds  and 
cured  the  diseases  of  cross-bearing  knights  and  potentates. 

Salernum  preserved  and  taught  the  element  of  medicine,  as 
transmitted  through  the  Arabians,  from  the  seventh  to  the 
fourteenth  centuries,  during  which  period  it  was  the  chief  seat  of 
medical  learning  in  the  civilized  world. 

The  history  remains  as  one  of  the  most  brilliant  and  interesting 
chapters  of  the  dark  ages. 

When  Salernum  had  already  begun  to  decline,  and  Padua  was  in 
its  infancy,  the  School  of  Bologna  was  at  its  apogee.  Begun  in  the 
middle  of  the  eleventh  century  with  a  school  of  sacred  letters,  and 
civil  and  canonical  law,  by  the  close  of  the  thirteenth  century, 
there  had  been  added  schools  of  medicine  and  philosophy;  and  to 
it  had  been  attracted  in  a  single  year,  not  from  Italy  alone,  but 
from  every  part  of  Europe  as  far  north  as  the  British  Isles,  ten 
thousand  students.  To  Bologna  was  assigned  the  rare  privilege  of 
connecting  the  old  learning  and  the  new,  and  of  occupying  a 
place  of  equal  prominence  in  each.  Its  medical  school,  however, 
belongs  to  the  new,  for  it  begins  with  the  date  1260,  when  Taddeo 
di  Alderotto  came  from  Florence  and  began  the  teaching  and 
practice  of  medicine  in  Bologna.  .  .  Settled  in  Bologna  he  ac- 
quired, in  a  short  time,  extraordinary  celebrity  and  immense 
riches.   .    . 

To  the  spirit  which  from  his  professional  chair  he  infused  into 
the  teaching  and  study  of  medicine,  undoubtedly  is  due  the  high 
position  which  for  many  generations  thereafter,  the  School  of 
Bologna  continued  to  maintain  as  a  center  of  medical  teaching. 
It  needs  no  great  stretch  of  the  imagination  to  picture  somewhat 
of  the  effect  that  contact  with  such  a  man  might  have  in  molding 
the  character  of  his  young  neighbor  and  pupil,  the  chemist's  son 
(Mondino)  who,  a  few  years  later,  by  his  devotion  to  the  study 
of  human  anatomy,  was  to  re-establish  the  practical  pursuit  of 


104  MODERN  ITALIAN  SURGERY 

study  of  the  human  cadaver  as  the  common  privilege  of  the 
skilled  physician,  and  was  to  establish  his  own  name  ineffaceably 
on  the  records  of  medicine.  .    . 

During  the  early  years  of  the  Renaissance,  the  glory  of  the 
University  of  Bologna  was  its  school  of  medicine  and  the  glory  of 
the  school  of  medicine  was  its  teaching  of  anatomy.  As  the  restorer 
of  anatomy,  Mondino  has  ever  received  universal  acclaim.    .   . 

He  was  born  at  a  time  when  everywhere  throughout  Italy 
free  thought  was  being  awakened,  curiosity  and  speculative  auda- 
city were  being  encouraged  and  the  pursuit  of  learning  new  things 
had  seized  upon  all  classes.  There  is  no  figure  in  all  history  that 
represents  this  spirit  more  fully  than  Frederick  n  (i  194-1250), 
King  of  Sicily  and  Emperor  of  the  Holy  Roman  Empire,  the 
indomitable,  the  learned,  the  law  giver,  patron  of  the  arts  and 
sciences,  warrior  and  statesman.  For  nearly  fifty  years  he  was  the 
dominant  figure  in  the  life  of  Italy. 

The  study  of  anatomy,  before  and  after  Mondino, 
was  manifestly  cultivated  rather  as  an  appendage  of 
surgery  than  as  a  special  branch  of  medicine,  and  was 
confined  to  men  who  left  their  names  to  some  discovery, 
like  Matteo  da  Grado,  who  first  represented  and 
described  the  ovaries  in  the  proper,  correct  light; 
Alessandro  Achillini  of  Bologna,  who  first  described 
the  two  tympanal  bones,  termed  malleus  and  incus, 
showed  the  tarsus  consisting  of  seven  bones;  mentioned 
the  orifices  of  the  ducts  and  described  the  duodenum, 
the  ileum  and  the  colon;  and  later  Berengario  da  Carpi, 
author  of  a  compendium,  several  treatises  and  lectures 
in  which  he  rectifies  the  mistakes  of  Mondino. 

Da  Carpi  published  an  accurate  anatomical  work, 
in  which  he  describes  the  several  layers  of  tissues  of 
which  the  stomach  is  made,  and  for  the  first  time  the 
vermiform  appendix  of  the  cecum,  the  communication 
of  the  duodenum  with  the  gall-bladder,  and  the  finding 


UNIVERSITIES  IN  ITALY  105 

of  the  opening  of  the  biliary  duct  in  that  portion  of  the 
intestine. 

For  many  centuries  Italy  had  the  distinction  of 
being  the  country  of  the  most  eminent  anatomists, 
who  flourished  during  that  period  of  the  Renaissance,  a 
period  also  glorious  in  art  and  literature. 

Bartolomeo  Eustachio  who  described  the  part  of  the 
ear  which  bears  his  name,  left  anatomical  plates  which 
illustrate  almost  every  part  of  the  body;  Matteo  Realdo 
Colombo  completed  the  anatomy  of  the  bones;  while 
Gabriele  Falloppio,  although  he  described  in  a  masterly 
way  the  internal  anatomy  of  the  ear,  yet  his  name 
remains  attached  to  the  uteroperitoneal  canal  which  he 
discovered. 

The  specialist  remembers  the  description  of  the 
sphenoid  and  ethmoid  bones  of  Giovanni  Filippo 
Ingrassia,  and  the  work  of  Giulio  Cesare  Aranzi  on  the 
inferior  cornua  of  the  ventricles  of  the  cerebrum.  But 
every  student  is  familiar  with  the  name  of  Costanzo 
Varolio,  the  great  anatomist  and  lecturer  of  Bologna 
who  gave  his  name  to  the  organ  which  connects  the  cere- 
brum, cerebellum  and  medulla  oblongata. 

Costanzo  Varolio  was  the  greatest  anatomist  not  only 
of  Italy  but  of  the  whole  world,  and  although  he  died 
young,  he  left  works  which  place  him  among  the  greatest 
scholars  and  the  greatest  teachers  of  anatomy,  in  a 
particular  epoch  which  had  already  seen  the  splendid 
plates  of  Leonardo  da  Vinci  (Le  Tavole  Anatomiche), 
lately  so  carefully  reproduced  by  the  University  of 
Christiania  as  one  of  the  greatest  masterpieces  of  art. 

Hieronymus  Fabricius  ab  Aquapendente,  a  pupil  of 
Falloppio,  followed  Varolio's  work,  and  to  him  goes  the 


106  MODERN  ITALIAN  SURGERY 

merit  of  giving  to  anatomy  the  character  of  a  useful  as 
Well  as  an  accurate  science.  His  association  with  his 
pupil,  Giulio  Casserio  of  Piacenza,  famous  for  his 
physiological  discoveries,  connected  the  two  studies  of 
anatomy  and  physiology,  in  reference  to  the  vital 
functions  of  the  body,  thus  influencing  further  re- 
searches as  to  the  function  of  the  different  organs,  and 
leading  to  the  discovery  of  the  circulation  of  the  blood 
described  by  William  Harvey,  one  of  his  pupils  at  the 
University  of  Padua. 

The  history  of  anatomy  is  so  closely  connected  with 
the  various  names  of  Italian  anatomists  that  it  is  suffi- 
cient to  mention  only  the  principal  scholars  and  teachers 
to  find  some  sections  of  the  human  body  bearing  their 
names  as  discoverers  or  illustrators;  for  instance,  Gas- 
paro  Aselli;  Giovanni  Domenico  Santorini;  Marcello 
Malpighi;  Paolo  Mascagni;  Antonio  Scarpa;  Luigi 
Rolando;  Filippo  Pacini;  Eustachio;  Varolio;  Falloppio; 
Mondino;  Sarti;  Lanfranchi;  Bottallo;  Carlo  Giacomini 
and  many  others  flourishing  in  the  time  of  the  Italian 
Renaissance  and  the  years  following  up  to  the  present 
generation  of  new  Italy,  when  the  revival  of  the  ana- 
tomical studies  seems  to  proceed  with  the  same 
activity  as  those  of  surgery  on  a  road  of  wonderful 
achievement. 

There  are  at  present  seventeen  universities  in  Italy, 
all  under  the  control  of  the  Government,  with  a  com- 
plete course  of  medicine  and  surgery  of  six  years'  dura- 
tion. Each  is  administered  by  the  same  standard  and 
regulations,  and  provided  with  a  staff  of  professors  and 
instructors  elected  by  a  special  board  after  public 
examinations,  or  by  the  exhibition  of  some  scientific 


UNIVERSITIES  IN  ITALY  107 

studies  or  contributions  which  would  entitle  the  candi- 
date to  the  responsible  position  of  teacher. 

At  the  end  of  each  year  the  pupil  is  submitted  to  an 
examination  on  every  subject  taught  during  the  year  so 
as  to  ascertain  if  he  is  fitted  to  continue  the  courses 
which  follow. 

After  passing  successfully  the  six  yearly  examinations, 
the  candidate  is  admitted  to  a  final  public  debate  held 
before  the  faculty,  which,  after  a  favorable  vote,  confers 
upon  him  the  degree  of  Doctor  in  Medicine,  Surgery 
and  Obstetrics,  with  a  diploma  called  "Laurea,"  the 
final  legal  document  of  admission  into  the  practice  of 
the  profession. 

Since  the  unification  of  Italy  under  one  Government 
in  the  last  fifty  years,  the  standard  of  surgical  education 
has  rapidly  improved  in  every  one  of  the  universities, 
not  only  on  account  of  the  selected  staff  of  teachers, 
but  also  through  the  emulation  of  the  regional 
universities. 

It  is  well  to  state  here  that  the  standard  of  medical 
education  is  the  same  all  over  the  country,  that  no  medi- 
cal schools  are  recognized  or  even  permitted  in  Italy 
except  those  approved  by  the  Government  which  are 
under  the  control  of  the  universities,  and  that  nobody 
is  allowed  to  practice  medicine  or  surgery  unless  he  has 
received  the  proper  degree  of  "Laurea." 

All  the  surgical  schools  of  Italy  had  from  the  be- 
ginning of  her  unity,  a  vital  impulse  from  the  biological 
sciences,  of  which  the  leading  spirit  was  the  lamented 
Giulio  Bizzozzero.  Under  his  patient  and  able  tuition,  a 
great  many  distinguished  teachers  now  holding  the 
chairs  of  pathology  in  the  various  universities  were 


108  MODERN  ITALIAN  SURGERY 

educated,  filling  both  the  scientific  and  the  practical 
needs  of  the  surgical  schools,  building  laboratories, 
opening  surgical  clinics,  and  improving  scientific  knowl- 
edge by  experimental  work. 

At  present  the  surgical  training  at  the  Italian  uni- 
versities is  imparted  by  two  separate  sections:  The 
surgical  section  on  pathology,  which  is  essentially  a 
theoretic  school,  combined  with  the  examination  of  the 
patients;  and  the  surgical  clinic  to  which  are  attached 
the  diagnostic  and  the  operative  departments. 

A  host  of  free  docents  and  adjunct  professors  attend 
to  the  special  tuition  and  training  of  the  students  in  the 
laboratories,  in  the  hospitals,  and  at  the  bedside,  com- 
pleting the  theoretical  and  practical  education  with 
diagnostic  demonstrations  and  laboratory  researches 
drawn  from  the  abundant  clinical  cases  selected  for 
that  purpose. 

The  actual  number  of  universities  in  Italy  far  exceeds 
the  needs  of  the  country.  Before  the  unification  of  Italy, 
when  the  country  was  divided  still  into  small  kingdoms 
and  principalities,  the  existence  of  a  university  for  each 
state  was  justified,  especially  for  political  reasons.  At 
present,  political  and  social  reasons  have  disappeared 
in  the  face  of  national  unity,  and  modern  facilities  of 
communications  have  eliminated  the  necessity  for 
local  universities.  The  Nationalist,  besides,  finds  that 
the  mixing  of  the  various  elements  of  the  population 
improves  the  national  unity  of  the  country. 

The  concentration  of  these  scientific  centers  would 
no  doubt  strengthen  the  economic  force  in  the  univer- 
sities retained;  it  would  give  a  chance  to  establish 
large  clinics,  to  furnish  perfectly  equipped  laboratories, 


UNIVERSITIES  IN  ITALY  109 

to  promote  more  uniformity  of  work,  and  to  provide 
facilities  for  the  exchange  of  knowledge,  thus  fostering 
progress  in  science.  It  would  eventually  attract  more 
attention  from  the  outer  world,  and  place  these  great 
centers  of  study  in  contact  with  the  scientific  students 
of  foreign  countries  to  the  benefit  and  advancement  of 
intellectual  and  practical  human  welfare. 


Chapter  XI 
THE  UNIVERSITY  OF  ROME 

ROME,  since  September  20,  1870,  has  been  the 
capital  of  the  Kingdom  of  Italy.  On  that  day, 
Rome  ceased  to  represent  only  the  two  great 
historical  epochs  of  the  past,  and  became  the 
head  of  a  new  nation,  the  capital  of  United  Italy. 

It  is  not  the  place  here  to  review  the  historical 
events  of  the  last  century,  when  the  dream  of  Dante 
and  the  aspirations  of  so  many  worthy  patriots 
materialized  under  the  persistent  intellectual  work, 
the  courageous  undertaking,  and  the  sublime  sacrifice 
of  lives  which  accompanied  the  long  struggle  for  the 
liberation  of  Italy  from  foreign  bondage  and  slavery. 

Suffice  it  to  say  that  Rome  and  the  Romans  took  a 
noble  part  in  the  struggle,  writing  in  the  history  of  the 
Italian  Revolution  one  of  the  most  glorious  pages, 
when,  in  1849,  they  strenuously  defended  the  Roman 
Republic  against  the  three  armies  of  the  Bourbons, 
of  Austria,  and  of  France,  succumbing  only  to  the  pre- 
ponderance of  the  enemy's  forces.  All  Italy's  thoughts 
turned  toward  the  new  capital,  which  represented  the 
final  achievement  of  her  long-sought  independence  and 
her  cherished  unification  under  one  flag. 

One  of  the  most  important  tasks  of  the  new  Govern- 
ment was  the  reorganization  of  the  universities  under 
one  standard,  abolishing  with  difficulty  many  old 
traditions  and  prejudices.  Some  of  the  most  prominent 


THE  UNIVERSITY  OF  ROME  in 

and  noted  scientists  of  Italy  were  called  to  Rome  to 
work  together  for  the  purpose  of  making  the  capital  a 
center  of  national  education,  of  making  Rome  worthy 
of  her  ancient  reputation  and  great  name. 

Large  appropriations  were  at  once  voted  by  Parlia- 
ment for  the  most  urgent  needs  of  the  city's  sanitation — 
the  diking  of  the  Tiber  with  colossal  walls  to  prevent 
the  annual  floods,  and  the  cleaning  of  ancient  quarters, 
turning  them  into  new  and  modern  buildings.  Soon 
the  city,  which  had  been  for  centuries  the  shop  of 
antiques  and  curios  and  the  museum  of  decaying 
monuments,  developed  into  a  beautiful  modern  city. 
Two  of  the  most  prominent  citizens  of  Rome,  scientists 
of  great  reputation,  Rodolfo  Lanciani  and  Giacomo 
Boni,  took  charge  of  the  delicate  task  of  preserving  the 
historical  monuments,  attending  with  great  care  and 
intelligence  to  the  new  excavations  and  discoveries 
for  the  benefit  of  students  and  the  advancement  of 
historical  knowledge  and  progress. 

Scientific  laboratories  for  the  study  of  malaria  and 
other  diseases  affecting  the  Roman  Campagna  were 
founded  by  the  Government  with  the  aid  of  private 
citizens,  and  several  special  commissions  were  organized 
for  the  study  of  sanitary  and  other  improvements  of 
the  great  city. 

An  active  crusade  against  illiteracy,  superstition  and 
ignorance  made  the  surroundings  of  Rome,  once  unsafe, 
unhealthy  and  deserted,  the  happy  resort  of  tourists 
and  travelers.  As  a  result,  more  than  twenty  years  ago, 
the  American  Consul  in  Rome,  Mr.  De  Castro,  sent 
a  consular  report  to  Washington,  published  in  the  news- 
papers of  that  time,  which  read : 


ii2  MODERN  ITALIAN  SURGERY 

To  my  previous  reports  I  will  add  that  Rome  is  now  well  paved 
and  well  cleaned.  Its  system  of  drainage  has  been  perfected  at 
enormous  cost,  and  there  has  been  sent  rushing  through  its  pipes 
one  of  the  most  remarkable  water  supplies  ever  known.  From  one 
source  alone  the  city  derives  millions  of  gallons  daily. 

The  Aqua  Marcia,  that  leads  all  the  way  from  the  Sabine 
Mountains  and  dates  from  146  B.C.,  was  restored  in  1869,  and  now 
brings  a  distance  of  nearly  sixty  miles  such  a  flood  as  to  contribute 
with  the  other  Roman  aqueducts  to  keep  the  city  in  one  endless  and 
royal  splash. 

The  numerous  colossal  fountains  of  Rome  know  no  pause,  all  day 
long  they  continue  their  spouting,  making  a  display,  beside  which 
the  fountains  of  Paris,  great  as  they  are,  are  downright  niggardly. 

And  now,  as  to  the  actual  effect  of  the  sun  in  Rome.  Yesterday, 
which  was  one  of  the  hottest  days  of  the  month,  the  thermometer 
registered  92  degrees.  This  in  New  York,  with  the  humidity  which 
so  often  prevails  there,  means  a  most  debilitating  state  of  atmos- 
phere. Here,  incredible  as  it  may  seem,  it  does  not  produce  unbear- 
able discomfort.  It  is  hot,  of  course,  but  the  air  is  light  and  dry; 
there  is  always  a  breeze  moving  and,  comparing  the  two  cities 
most  carefully,  I  should  not  hesitate  to  say  that  Rome,  on  a  day 
like  yesterday,  is  as  much  the  superior  of  New  York,  in  respect 
to  comfort,  as  is  many  an  American  town  among  the  mountains 
or  on  the  coast  that  is  patronized  as  a  summer  resort. 

The  nights  are  always  delightfully  cool,  and  there  is  no  difficulty 
in  obtaining  a  long  and  refreshing  sleep. 

Notwithstanding  the  frequent  protests  of  some  fana- 
tic lovers  of  antiquities  against  the  so-called  demolition 
of  ancient  Rome  (which  protests  were  once  wittily 
answered  by  an  energetic  mayor  of  the  city),  the  im- 
provements progressed  rapidly,  without  interfering 
with  the  work  of  excavation,  intelligently  directed 
by  Professor  Boni  and  so  profusely  illustrated  by  Pro- 
fessor Lanciani  above  mentioned. 

In   a  highly   interesting   letter,  dated   May,  19 16, 


THE  UNIVERSITY  OF  ROME  113 

Prince  Colonna,  then  Mayor  of  Rome,  discusses  the 
industrial  future  of  the  city,  and  foresees  great  advan- 
tages from  the  utilization  of  her  many  agricultural 
resources,  buried  in  the  "Agro  Romano,"  the  immense 
stretch  around  Rome.  He  claims  in  his  letter  that  many 
institutions  of  industrial  and  scientific  learning  could 
be  established  there,  making  it  a  center  of  economic 
and  commercial  advancement.  His  letter  was  an  answer 
to  another  prominent  Roman  patrician  who,  instead, 
wanted  to  make  of  Rome  an  aristocratic  center  of  sport 
and  luxury  so  as  to  attract  wealthy  foreigners. 

The  unexpected  and  fortunate  end  of  the  war,  which 
gave  to  Italy  such  a  different  standing  among  the  great 
nations  of  the  world,  placed  her  capital  in  a  much  higher 
social  position,  as  the  head  of  a  completely  united  nation 
of  more  than  40,000,000  people. 

Since  1 870  the  population  of  Rome  has  been  growing 
at  the  rate  of  20,000  a  year,  and  has  now  a  large  area 
built  with  modern  houses,  villas  and  apartments  to 
rival  any  of  the  most  modern  cities  of  the  world.  The 
reason  for  such  a  rapid  increase  of  population  can  be 
ascribed  to  her  healthful  and  salubrious  location,  to  her 
climate,  to  the  splendid  organization  of  her  public 
services,  to  the  exceptional  abundance  of  water  con- 
sidered as  pure  as  if  filtered,  to  the  perfect  system  of 
drainage,  to  the  absence  of  manufacturing  centers  and  the 
scarcity  of  a  working  population,  facts  which  make  con- 
tagious diseases  less  frequent  and  residence  there  pref- 
erable to  any  other  big  city  in  Europe. 

Rome's  water  supply  is  a  marvel.  The  four  main 
aqueducts — the  Marcia,  the  Felice,  the  Paola  and  the 
Vergine — come  to  the  city  from  a  long  distance,  giving 


ii4  MODERN  ITALIAN  SURGERY 

Rome  1,028,243  cubic  feet  of  water  per  day  at  a  rate 
of  400  gallons  per  head  while  London  has  30  and  Paris 
40  gallons  only  per  capita. 

The  days  of  bad  sanitation  and  bad  administration 
are  past,  for,  although  the  Roman  municipal  authorities 
are  not  perfect,  a  very  efficient  control  is  maintained 
over  the  city,  and  the  management  of  its  affairs 
improves  year  by  year.  When  one  comes  to  consider 
the  physical  well-being  of  the  Roman  population,  one 
sees  that  any  statement  against  the  healthfulness  of 
the  city  is  not  in  accordance  with  facts,  for  a  healthy 
population  cannot  exist  in  an  unhealthy  city.  The 
people  of  Rome  are,  on  the  whole,  remarkably  healthy. 
Even  the  poorer  classes  who  live  in  rather  crowded,  not 
always  hygienically  kept  quarters,  enjoy  comparative 
immunity  from  sickness,  which  can  only  be  explained 
by  the  purity  and  salubrity  of  the  air  and  atmosphere 
of  the  city  and  its  surroundings. 

The  climate  of  Rome  is  pleasant  and  mild  during  the 
winter,  which  is  short,  lasting  only  from  December  to 
February,  when  spring  may  be  said  to  begin.  Only  one 
month  of  summer  is  unpleasantly  hot  and  even  in 
August  the  nights  are  cool. 

The  excellent  guide  to  the  province  of  Rome  by  E. 
Abbate,  mentions  several  health  resorts  around  the 
city,  famous  during  many  centuries  for  their  curative 
qualities  in  various  diseases.  Very  popular  is  the  "  Acqua 
Cetosa,"  just  outside  the  Porta  del  Popolo,  close  to 
the  bend  of  the  Tiber,  and  the  "Acqua  Santa"  near 
the  so-called  "Grotto  of  the  Nymph  Egeria"  outside 
Porta  San  Giovanni,  along  the  Via  Appia  Nuova. 
Both  waters  are  sold  everywhere  for  drinking  purposes, 


THE  UNIVERSITY  OF  ROME  115 

and  are  considered  beneficial  in  nervous  troubles  due  to 
stomach  and  kidney  impairments. 

Famous  also  is  the  "Acque  Albule,"  so  called  from 
their  milky  color.  This  spring  gives  60,000,000  of  gallons 
of  water  per  day,  providing  a  complete  modern  bathing 
establishment,  situated  in  picturesque  grounds,  with 
every  convenience  for  treating,  under  medical  direction, 
diseases  of  the  kidney,  bladder,  gout  and  rheumatic 
affections.  Annexed  to  the  establishment  are  several 
open-air  swimming  pools  which  are  well  patronized 
during  the  summer  by  excursionists  from  the  city,  the 
distance  being  only  one  hour  by  car. 

Another  sulphurated  hydrogen  water,  similar  to  the 
"Albule,"  is  that  of  "Stigliano,"  near  Civitavecchia. 
One  of  the  springs  there  has  a  temperature  of  133 
degrees  and  is  wonderfully  beneficial  in  chronic  rheu- 
matism and  rebellious  skin  diseases.  Some  other 
mineral  springs:  Sferracavallo,  Ficoncella,  and  Palazzi, 
also  near  Civitavecchia,  are  popular  in  similar  diseases. 

A  very  popular  drinking  water,  like  the  White  Rock 
of  America,  comes  from  Fiuggi  (near  the  picturesque 
village  of  Anticoli  di  Campagna,  a  short  distance  from 
the  city  of  Prosinone),  where  a  very  enterprising 
company  has  built  hotels  and  establishments  well 
patronized  by  the  social  world  of  the  capital. 

The  University  of  Rome  like  many  of  the  Italian 
universities  had  its  origin  toward  the  end  of  the 
thirteenth  and  the  beginning  of  the  fourteenth  centuries. 
It  was  founded  by  Pope  Boniface  vm  for  the  benefit  of 
impecunious  students  who  came  to  Rome  from  other 
parts  of  Italy  or  from  foreign  countries. 


u6  MODERN  ITALIAN  SURGERY 

The  university  went  through  the  many  vicissitudes 
of  war,  pestilence  and  invasions,  which  reduced  the 
number  of  students,  sometimes  the  number  included 
only  the  teachers.  Besides,  the  restrictions  upon  the 
teaching  of  liberal  ideas  greatly  hampered  the  progress 
of  study. 

After  1870,  the  surgical  clinic  was  temporarily 
placed  at  the  San  Giacomo  Hospital,  under  the  direction 
of  Professor  Corradi,  who  was  called  from    Florence. 

Later,  Costanzo  Mazzoni  succeeded  Corradi,  notably 
enlarging  the  clinic  and  introducing  the  Lister  antiseptic 
method.  A  man  highly  educated,  well  posted  upon  the 
progress  of  surgery  abroad,  where  he  had  spent  some 
time  visiting  French,  English  and  German  clinics, 
Mazzoni  selected  some  of  the  best  men  as  assistants, 
among  them  his  nephew  Gaetano  Mazzoni,  Paolo  Pos- 
tempski  and  Francesco  Durante,  who  afterward  became 
the  leaders  of  the  surgical  school  at  Rome.  A  skillful 
operator  and  learned  lecturer,  Costanzo  Mazzoni 
left  many  valuable  works  and  a  great  many  pupils 
who  honor  his  name. 

At  his  death  in  1885,  Francesco  Durante,  who  was 
his  first  assistant  and  professor  of  surgical  pathology, 
succeeded  him  in  the  chair  of  clinical  surgery,  which  he 
moved  to  the  new  Polyclinic  Hospital,  promoted  and 
brought  to  completion  by  the  genius  of  Guido  Baccelli, 
the  eminent  professor  of  clinical  medicine  at  the 
University  of  Rome.  Francesco  Durante  held  the  chair 
of  clinical  surgery  from  1885  to  191 9,  when,  by  reason 
of  the  age  limit,  he  was  regretfully  retired.  The  work 
of  Durante  as  a  teacher,  as  a  scientist  and  as  a  surgeon, 
has  been  marvellous,  and  of  him  it  can  be  said  that  he 


'      0 


Dr.  Guido  Baccelli,  Rome. 


THE  UNIVERSITY  OF  ROME  117 

succeeded  to  perfection  in  coupling  science  with  art 
in  surgery.  Before  he  assumed  the  chair  of  clinical 
surgery  he  had  been  professor  of  embryology  and 
histopathology  and  brought  to  the  operating  room  full 
knowledge  of  those  two  important  parts  of  modern 
surgical  practice. 

Long  before  Cohnheim,  Durante  published  a  histo- 
logic study  of  maternal  moles,  in  which  he  proved  that 
tumors  can  derive  from  cellular  elements  keeping  the 
embryonal  character.1  In  a  very  important  volume 
published  in  1876,  "Surgical  Diagnosis  of  Tumors," 
he  presents  his  theory  in  such  a  clear  way  that  his  book 
can  be  used  as  a  text  for  the  student.  Another  of  his 
books,  "Surgical  Pathology  and  Therapy,"  used  also 
as  a  text  by  the  students,  is  a  complete  treatise  on  the 
subject.  It  would  take  too  long  to  enumerate  here  his 
works  on  surgery  of  the  brain,  on  resection  of  the 
cecum  for  tuberculosis,  and  on  resection  of  the  larynx 
by  anterior  flap  of  the  neck,  with  immediate  suture  of 
the  pharyngeal  opening  with  "prima  intentio"  healing. 
The  injection  of  iodides  in  surgical  tuberculosis,  which 
is  still  used  successfully  in  his  clinic  and  in  most 
of  the  clinics  throughout  Italy,  is  one  of  his  original 
findings. 

His  successor,  Roberto  Alessandri,  his  assistant  for 
many  years  in  the  chair  of  surgical  pathology,  is,  with 
the  other  assistants,  contributing  to  the  compilation 
of  the  last  work  of  Professor  Durante — "The  Treatise 
on  Operative  Medicine,'*  which  will  be  a  voluminous 
and  complete  work  of  practical  surgery. 

Of  Professor  Alessandri's   numerous   publications, 

1  Palasciano  Arcb.,  ii. 


n8  MODERN  ITALIAN  SURGERY 

those  worthy  of  mention  are — "The  Experimental 
Study  on  Surgery  of  the  Kidney,"  "Surgery  of  the 
Gall-Bladder  and  Adnexa,"  "Hernia  of  the  Bladder 
and  its  Pathogenesis,"  "Diagnosis  and  Treatment  of 
Tumors  of  the  Bladder,"  "Pseudotuberculosis  of  the 
Peritoneum  from  Vegetable  Residue,"  and  "  Importance 
and  Limits  to  the  Bloodless  Treatment  of  Surgical 
Tuberculosis." 

Professor  Alessandri's  address  is  rigorously  scientific 
and  his  teaching  shows  a  wonderful  modern  activity 
which  has  inspired  some  of  his  pupils  to  follow  his 
example  in  original  researches  and  publications.  As 
colonel  in  the  reserve,  he  was  at  the  front  and  gained  the 
silver  medal  for  valor.  He  has  published  some  valuable 
pamphlets  on  war  surgery. 

The  Surgical  Clinic  is  connected  with  the  Ministry 
of  Public  Education.  It  disposes  of  80  beds,  with  the 
privilege  of  selecting  material  from  every  hospital  in 
Rome.  The  Clinic,  besides,  has  very  large  commodious 
rooms  for  attendance  and  service  in  that  beautiful  and 
great  Polyclinic,  at  the  entrance  of  which  stands  a 
large  marble  bust  representing  "Lord  Lister,"  in  honor 
of  his  great  work  on  antisepsis.  This  fact  ought  to 
persuade  Sir  Rickman  Godlee  of  the  great  mistake 
made  in  his  book  on  "Lord  Lister"  in  which  he  treats 
Italy  almost  as  a  savage  country. 

Besides  the  numerous  laboratories,  and  a  large  stable 
for  the  care  of  the  animals  intended  for  experimental 
work,  there  are  a  pathological  museum,  a  library  and  a 
big  lecture  hall  with  an  amphitheatre  for  operations. 
Annexed  to  the  Surgical  Clinic,  is  the  institute  for  the 
treatment  of  diseases  of  the  eyes  under  the  direction  of 


THE  UNIVERSITY  OF  ROME  119 

an  able  specialist,  Prof.  Giuseppe  Cirincione;  a  depart- 
ment for  eyes,  nose,  and  throat  under  Professor  Ferreri; 
one  for  gynecology  under  Professor  Pestalozza;  and  one 
for  orthopedics  and  traumatology  under  Prof.  Della- 
Vedova. 

There  are  at  the  Polyclinic  three  separate  surgical 
sections  of  76  beds  each,  under  the  direction  of  Prof. 
Raffaele  Bastianelli,  Roberto  Alessandri  and  Oreste 
Margarucci.  Each  one  is  amply  furnished  with  its  own 
laboratories,  operating  rooms,  equipments  and  several 
assistants  for  the  instruction  of  the  students  and  physi- 
cians in  need  of  a  post-graduate  course.  In  each  one 
of  these  sections  the  number  of  operations  averages 
between  800  and  1 ,000  a  year. 

Prof.  Raffaele  Bastianelli,  well  known  to  Ameri- 
can surgeons  through  his  frequent  participation  in  the 
Surgical  Congress  in  the  United  States,  was  also  in  the 
Reserve  Corps  during  the  war,  directing  one  of  the  mov- 
able hospitals  at  the  immediate  front,  where  he  had  the 
opportunity  of  performing  a  great  many  operations  in 
thoracic  and  abdominal  surgery  when  immediate  inter- 
vention was  necessary. 

In  191 8,  at  the  Surgical  Congress  held  in  the  United 
States  just  before  the  end  of  the  war,  he  delivered 
several  lectures  on  thoracic  surgery,  and  on  the  results 
of  his  experience  at  the  front,  including  most  valuable 
statistics  of  numerous  cases,  in  which  Morelli's  method 
was  successfully  used  to  stay  hemorrhage  in  the  lungs. 
Bastianelli's  extensive  contribution  to  scientific  sur- 
gery is  familiar  to  most  of  the  leading  surgeons  01 
America.  Well  known  are  his  contributions  relating 
to  tumors  of  the  mouth  and  tongue,  general  abdominal 


120  MODERN  ITALIAN  SURGERY 

surgery,  surgery  of  the  stomach,  liver  and  biliary 
appendage;  and  to  the  study  of  degeneration  of  paren- 
chymatous organs  through  poisoning  by  chloroform. 

He  also  demonstrated  the  practical  use  of  Vanghetti's 
method  in  cinematic  surgery  for  the  utilization  of 
muscular  loops  in  amputations,  including  the  advan- 
tages that  it  can  give  to  the  action  of  artificial  limbs 
after  war  injuries. 

Besides  lecturing  at  the  Polyclinic,  always  to  a  large 
audience  of  students  and  professional  men  eager  to  learn 
from  his  skillful  operations,  Bastiartelli  has  a  private 
hospital  (Viale  della  Regina,  203)  where  he  performs  a 
great  many  operations,  especially  assisted  by  Dr. 
Vittorio  Puccinelli,  who  is  one  of  the  promising  young 
practitioners  of  Rome  with  many  valuable  publications 
to  his  credit. 

The  third  director  of  a  surgical  section  at  the  Poly- 
clinic is  Prof.  Oreste  Margarucci,  a  very  distinguished 
surgeon  and  author  of  several  very  important  publica- 
tions: "On  Peritoneal  Tuberculosis,"  "  Arterial  and 
Venous  Circulation  of  the  Ureters,"  "Bony  Regenera- 
tion," and  "Surgery  of  the  Biliary  Organs." 

Besides  the  Polyclinic,  Rome  has  a  number  of  con- 
spicuous hospitals,  some  quite  old  like  the  Santo  Spirito, 
San  Giovanni  and  San  Giacomo,  which  have  been 
recently  improved  with  all  the  modern  appliances 
and  advantages,  and  some  perfectly  new— furnished 
throughout  with  the  latest  scientific  and  practical 
needs  of  the  present  time,  of  which  the  military  hospital 
is  a  model.  The  head  surgeon  of  the  San  Giovanni  is 
Prof.  Gaetano  Mazzoni,  one  of  the  most  brilliant  oper- 
ators, who  has  contributed  to  the  surgical  literature 


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THE  UNIVERSITY  OF  ROME  121 

some  very  valuable  works  on  abdominal,  thoracic  and 
bone  surgery. 

Prof.  Paolo  Postempski  has  been  identified  for  a 
great  many  years  with  the  San  Giacomo  Hospital, 
which  he  has  modernized,  building  and  equipping  the 
operating  rooms  and  laboratories  according  to  the  latest 
scientific  requirements. 

The  popular  publications  of  Professor  Postempski  in- 
clude articles  on  surgery  of  the  articulations,  and  thor- 
acic and  abdominal  surgery,  and  it  is  worthy  of  mention 
that  he  made  the  original  diaphragmatic  laparotomy 
and  published  an  article  on  it  in  the  Rijorma  Medica. 

At  the  San  Antonio  Hospital,  Prof.  Vincenzo  Mon- 
tenovesi  did  some  remarkable  original  work  in  brain 
surgery  in  which  he  is  considered  an  authority. 

Mention  must  be  made  here  of  the  principal  teachers 
of  general  and  special  clinical  pathology  who  have  dis- 
distinguished  themselves  because  of  their  valuable 
work — like  Profs.  Amico  Bignami,  Eugenio  Rossoni  and 
Achille  Boari  in  surgical  anatomy,  who,  with  Umberto 
Arcangeli,  Oreste  Ferraresi  and  Alessio  Nazari,  lecture 
on  pathology,  anatomy  and  histology.  Eugenio  Cassini 
occupies  himself  at  the  general  surgical  clinic,  and 
Giovanni  Impallomeni  devotes  himself  to  instruction 
in  orthopedics. 

The  large  staff  of  adjunct  professors  of  surgery  is 
necessary  for  the  needs  of  the  many  ambulatories  estab- 
lished in  the  different  sections  of  the  city  and  for  the 
inspections  outside  the  city,  thus  giving  to  Rome  one 
of  the  most  perfect  systems  of  medical  attendance  a 
modern  city  can  desire. 

1 1890,  i,  647. 


Chapter  XII 
THE  UNIVERSITY  OF  BOLOGNA 

THE  University  of  Bologna  should  be  the  first 
to  be  mentioned  in  this  book  because  of  its 
ancient  origin  and  its  scientific  and  histori- 
cal importance,  while  Rome  takes  precedence 
only  for  political  and  national  reasons. 

Tradition  ascribes  its  foundation  to  Theodosius  n 
(Roman  Emperor  of  the  East  from  408  to  450)  in  the 
fifth  century,  but  the  historical  date  of  the  university's 
foundation  has  now  been  fixed  as  1088,  since  it  was  at 
about  that  period  that  the  famous  Irnerius  began  to 
teach  Roman  law,  philosophy  and  letters,  lectures  which 
attracted  multitudes  of  students  from  all  over  the  world. 
For  that  reason,  in  the  summer  of  1888,  Bologna  cele- 
brated its  octocentenary  festival  with  great  pomp. 
All  the  Governments  of  foreign  nations  were  repre- 
sented— America,  by  Prof.  W.  Story  of  the  National 
Academy  of  Sciences,  Washington,  D.  C.,  who  delivered 
his  speech  on  behalf  of  the  United  States. 

Originally  the  ancient  Etruscan  Felsina  was  colon- 
ized by  the  Romans  in  190  b.c;  afterward  it  was  made 
a  free  city  by  Charlemagne.  Ancient  coins  bear  the 
legend  "Bononia  Docet,"  from  its  fame  as  a  seat  of 
learning. 

Bologna  is  interesting  for  its  monuments,  its  famous 
towers,  the  picturesque  buildings  with  arcades,  the 
palaces,  the  churches,  and  for  a  population  noted  for  its 
traditional    good    looks    and    robust    appearance.    It 


Prof.  RafTaele  Bastianelli,  Rome. 


THE  UNIVERSITY  OF  BOLOGNA  123 

owes  its  popularity  to  its  wealth  and  prosperity  as  the 
center  of  one  of  the  richest  provinces  of  Italy. 

The  city  is  famous,  not  only  for  its  ancient  origin,  its 
wealth  and  interesting  monuments,  but  also  because 
its  inhabitants  have  always  been,  and  especially  during 
the  last  century,  among  the  foremost  champions  of  the 
independence  of  Italy.  In  the  year  1848  the  population 
of  Bologna  vigorously  repulsed  a  superior  force  of  Aus- 
trians  and  in  1849  a  patriotic  priest,  Ugo  Bassi,  was 
executed  for  his  devotion  to  the  cause  of  Italian  liberty. 
Later,  Count  Aurelio  Saffi  was,  with  Mazzini  and  Gari- 
baldi, a  defender  of  the  Roman  republic. 

It  was  at  the  University  of  Bologna  that  lectures 
were  delivered  by  Malpighi,  Valsalva,  Morgagni,  Gal- 
vani,  Aldrovandi,  Marsigli,  Zambeccari,  and  many 
others  famous  throughout  the  world.  The  present 
school  of  surgery  of  Bologna  is  one  of  the  best,  not  only 
in  Italy  but  also  in  Europe.  It  is  that  admirable  school 
which  has  been  supplying  for  a  great  many  years  past 
so  many  distinguished  surgeons  to  the  numerous  hospi- 
tals of  the  large  and  small  cities  of  the  compartimentos 
of  Emilia  and  Romagna,  the  two  most  prosperous  prov- 
inces of  northern  Italy. 

The  old  glorious  traditions  have  not  been  lost,  for, 
after  the  death  of  the  famous  Dr.  Francesco  Rizzoli, 
toward  the  middle  of  last  century,  his  successor,  Prof. 
P.  Landi,  left  important  contributions  to  literature 
on  almost  every  surgical  case  which  he  had  treated 
with  singular  skill  and  success.  And  so  did  another 
famous  surgeon,  Prof.  P.  Loreta,  well  known  throughout 
the  surgical  world  for  his  treatment  of  pyloric  and 
cardiac  strictures  by  digital  divulsion,  and  for  his  many 


i24  MODERN  ITALIAN  SURGERY 

original  publications  on  the  surgery  of  the  liver  and 
intestines. 

The  chair  of  surgery,  held  by  Prof.  A.  Poggi,  was 
later  occupied  for  several  years  by  Prof.  G.  F.  Novaro, 
and,  finally,  until  last  year,  by  Prof.  G.  Ruggi  who  re- 
tired because  of  the  age  limit,  to  the  great  regret  of  his 
colleagues  and  students. 

Prof.  G.  Ruggi  has  been  one  of  the  most  original  and 
successful  teachers  of  modern  surgery.  In  surgical 
literature  his  method  of  radical  cure  for  crural  hernia 
by  the  inguinal  process,  his  special  method  of  vaginal 
hysterectomy  and  abdominal  sympathectomy  in  cases 
of  obstinate  utero-ovarian  neuralgia,  also  his  original 
technique  for  the  resection  of  the  knee  and  for  abdomi- 
nal operation  in  large  cystomata  of  the  uterus,  are  well 
known  in  surgical  literature,  and  are  practiced.  But  to 
Professor  Ruggi  is  due  the  credit  for  having  popularized 
the  method  of  the  antisepsis  of  Lister  in  Italy  by  means 
of  two  well-known  publications  (1878- 1879),  tne  value 
of  which  is  enhanced  by  ample  statistics,  which  clearly 
contradict  the  gratuitous  assertion  of  Sir  Rickman 
Godlee,  in  his  volume  on  Lord  Lister  (London,  191 7). 

In  1888  Professor  Ruggi  published  statistics  of  100 
cases  of  laparotomy  which  he  had  performed  with  16  per 
cent  mortality,  and  ten  years  later,  statistics  of  1,000 
cases  of  laparotomy  with  only  2  per  cent  mortality. 
Proud  of  the  Italian  school  of  surgery  in  which  he  has 
been  such  a  worthy  champion  all  his  life  long,  in  his 
inaugural  speech  at  the  opening  of  the  annual  course  of 
lectures,  he  said:  "We  in  Italy  have  been  too  prone  to 
admire  foreign  work,  neglecting  often  what  we  have 
done   at  home,   which  we  only   know   from   foreign 


THE  UNIVERSITY  OF  BOLOGNA  125 

publications.  It  is  now  time  that  such  servitude,  which 
is  looked  upon  with  contempt  by  foreigners,  should 
cease,  by  starting  a  just  appreciation  of  our  own  great 
work,  of  what  we  really  can  do  at  home,  and  of  which  we 
can  and  we  must  be  proud." 

The  special  chair  of  surgical  pathology  has  been  held 
by  Prof.  Alfonso  Poggi,  a  pupil  of  Prof.  Guido  Tizzoni 
(of  tetanus  fame)  and  of  Professor  Loreta.  Professor 
Poggi  has  to  his  credit  some  very  interesting  work  on 
osteoarticular  surgery  and  an  original  publication  on 
rare  echinococcus  of  the  retro  vaginal  septum.  Original 
are  also  his  publications  on  primary  healing  of  wounds 
dressed  with  carbolic  acid  solutions,  including  deep 
burns  and  large  contusions.  His  abundant  literature 
deals  also  with  classical  works  on  the  gall-bladder  and 
the  technique  of  its  reconstruction,  with  primary  healing 
of  wounds  of  the  stomach,  and  reconstruction  of  the 
mucous  intestinal  layer  of  the  jejunum. 

Interesting  also  are  Poggi*  s  experiments  on  the  repro- 
duction of  the  pocket  of  the  gall-bladder  after  cholecys- 
tectomy, demonstrating  the  necessity  of  resecting  the 
gall-bladder  as  near  as  possible  to  the  choledochus  to 
avoid  the  return  of  calculi. 

Ruggi,  after  his  retirement  as  professor  on  account 
the  age  limit,  was  succeeded  by  Prof.  Bartolo  Nigrisoli 
as  lecturer,  on  account  of  a  long  and  extensive  exper- 
ience, especially  in  abdominal  surgery  of  the  liver  and 
spleen. 

The  surgical  faculty  of  Bologna  has  other  dis- 
tinguished teachers  who,  in  the  various  clinics  of  the 
Ospedale  Maggiore  or  Ospedale  di  St.  Orsola,  lecture 
to  the  students  and  young  doctors.  Among  the  best 


126  MODERN  ITALIAN  SURGERY 

known  for  their  technique  is  Prof.  Umberto  Monari, 
who  has  contributed  largely  to  the  surgical  literature  of 
the  intestines,  of  the  uterus,  and  of  the  ureters.  He  has 
reported  a  case  of  Gasserian  ganglion  operation.1  Prof. 
Benedetto  Schiassi,  another  famous  surgeon,  published 
very  interesting  studies  on  the  treatment  of  the  ascitic 
abdomen  in  cirrhosis  of  the  liver,  with  the  surgical 
deviation  of  the  blood  to  the  portal  vein ;  on  the  movable 
kidney;  besides  several  other  cases  of  high  abdominal 
surgery.  Profs.  Egisto  Magni  and  Ulisse  Gardini  have 
also  furnished  important  contributions,  the  former  on 
transfusion,  the  latter  on  prostatectomy,  which  have 
received  considerable  attention  from  professional  men. 
Radioscopy  is  so  closely  connected  with  surgery  that 
it  is  worth  while  mentioning  here  the  importance  that 
this  special  branch  of  study  has  in  the  University  of 
Bologna.  Lately,  on  the  initiative  of  Prof.  Aristide  Busi, 
director  of  the  department  of  radioscopy,  the  radiol- 
ogists of  the  province  of  Emilia  decided  to  hold 
periodical  reunions  for  the  purpose  of  discussing  the 
progress  of  radiotherapy.  The  first  of  these  reunions  took 
place  at  Villa  Verde,  in  the  Institute  of  Radiology  of 
Professor  Busi.  There  were  present,  besides  Professors. 
Busi,  Bifri  and  Balli,  Drs.  Rossi,  Sighinolfi,  Palmieri, 
Maffeo,  Tarugi,  Fiorini,  Magni,  Ramusani,  Tapparelli, 
Pini,  and  Montanari.  After  an  exhibition  of  the  various 
departments  of  the  institute  by  Professor  Busi,  who 
showed  the  numerous  and  perfect  instruments  made 
at  the  well-known  factory  of  Balzarini  &  Gorla  in 
Milan,  and  gave  a  demonstration  of  the  different  appli- 

1Beitr.    z.    klin.  Cbir.,  Tubing   1896,  xvn.  Ein  Fall  von  Resection  des 
Gasser'schen  Ganglion. 


THE  UNIVERSITY  OF  BOLOGNA  127 

cations  of  the  apparatus  in  medicine  and  surgery,  some 
plates  yielded  the  opportunity  for  a  scientific  dis- 
cussion on  differential  diagnosis,  and  also  the  applica- 
tion of  new  methods  in  the  treatment  of  infantile  coxitis 
by  x-rays  as  advanced  by  Tarugi.  Of  such  reunions, 
which  promise  to  be  frequent,  a  report  will  be  given  to 
the  public  in  a  special  review. 

Bologna  is  a  city  of  learning,  a  center  of  modern 
progressive  education  which  earnestly  follows  the 
traditions  of  its  glorious  past.  Besides  treasures  of  old 
monuments,  interesting  palaces,  artistic  churches,  odd 
and  curious  arcades,  filled  with  precious  collections  of 
paintings  and  sculptures  of  historical  import,  which 
make  Bologna  an  attractive  place  to  visit,  there  is  a 
modern  part  of  the  city  covered  by  imposing  and  elabor- 
ate buildings  devoted  to  scientific  study  and  research. 
Each  building  is  an  institute  of  scientific  learning, 
of  architectural  elegance,  surrounded  by  attractive 
gardens,  and  furnished  with  all  the  scientific  modern 
equipment  necessary  for  teaching  and  demonstration 
to  students. 

In  the  medical  department  is  the  remarkable  Institute 
of  Normal  Human  Anatomy,  worthy  of  the  tradition 
of  the  famous  school  of  anatomy  of  Bologna  which 
for  seven  centuries  held  the  primateship  in  the  world 
because  of  Mondino  de'Liuzzi  (d.  1326)  Berengario 
da  Carpi  (d.  1536),  Andreas  Vesalius  (d.  1564),  Giulio 
Cesare  Aranzi  (d.  1589);  Costanzo  Varolio  (d.  1575), 
Marcello  Malpighi  (d.  1694),  Antonio  Valsalva  (d.  1723), 
Leopoldo  Caldani  (d.  1760) — names  familiar  to  every 
student  of  anatomy. 

This  building  has  two  large  halls,  one  in  the  form  of 


128  MODERN  ITALIAN  SURGERY 

an  amphitheater  with  a  seating  capacity  of  three 
hundred,  with  an  annex  for  dissecting  purposes  seating 
over  a  hundred  students  at  one  time.  There  is  also  a 
small  amphitheater  for  annual  lectures  with  a  hall 
annexed  for  dissections  needed  for  the  lectures,  a  special 
laboratory  for  assistants,  and  rooms  for  photography, 
for  the  storage  of  cadavers  and  preparations,  the  under- 
ground deposit;  the  upper  floor  for  the  collections,  the 
library  and  directors*  offices. 

The  annexed  museum  contains  two  thousand  speci- 
mens, some  from  the  time  of  Valsalva,  and  two  thousand 
craniums  catalogued  by  Luigi  Calori.  The  institute  is 
well  provided  with  all  the  most  modern  means  for 
demonstrations:  a  large  epidiascope,  apparatus  for 
morphological  and  histological  projections,  microscopes, 
binoculars,  stereoscopes,  ultramicroscopes,  a  special 
apparatus  for  wax  reproductions  of  embryos;  in  fact, 
everything  that  modern  science  requires  for  that  branch 
of  study. 

Adjacent  to  the  Institute  of  Normal  Human  Anatomy 
is  the  Institute  of  Pathological  Anatomy,  provided  with 
a  large  amphitheater,  and  a  large  laboratory  for 
histological,  bacteriological  and  chemicopathological 
experiments,  beside  sample  rooms  for  vivisections,  a 
museum,  library,  rooms  for  private  experiments  and 
for  the  directors.  It  is  also  furnished  with  a  large 
apparatus  for  projections,  a  frigorific  room  for  cadavers 
and  a  crematory  for  animals.  The  museum  has  a  rich 
collection  of  more  than  2,000  specimens,  some  very  origi- 
nal and  rare,  collected  by  the  late  Prof.  Cesare  Taruffi. 

Mention  must  be  made  here  of  the  new  Institute  of 
Anthropology,  established  especially  for  the  large  collec- 


c 


bfi 


THE  UNIVERSITY  OF  BOLOGNA  129 

tion  and  of  biologic  and  anthropometric  instruments 
with  which  it  is  provided  for  use  in  connection  with 
criminal  anthropology. 

The  most  important  institutes  are  those  of  experi- 
mental physics,  of  experimental  physiology,  and  of 
histology  and  general  physiology:  the  last  one,  inter- 
rupted by  the  Great  War,  is  now  nearing  completion.  All 
three  institutes  are  well  provided  with  instruments, 
apparatus  and  materials  for  demonstrations,  as  well 
as  museums  and  libraries  for  the  convenience  of  students 
and  frequenters  of  the  schools. 

The  medical  and  surgical  clinics  and  the  various 
special  clinics  are  all  annexed  to  the  St.  Orsola  Hospital 
and  the  other  numerous  hospitals  of  Bologna.  Of  the 
Rizzoli  Orthopedic  Institute,  a  full  description  has 
already  been  given  in  a  separate  chapter,  in  which  the 
orthopedic  schools  of  Italy  receive  the  attention  they 
deserve. 

Before  closing  this  chapter  reference  should  be  made 
to  the  opinion  which  is  popular  among  the  intellectual 
classes  of  Italy,  that  Bologna  will  be  the  center  of  future 
university  activities  in  Italy,  a  sort  of  post-graduate 
study  and  education  for  the  world.  It  is  certainly 
difficult  to  predict  what  will  be  the  intellectural  future 
of  Italy  in  Europe,  but  with  the  favorable  location  of 
Bologna  only  a  few  hours  by  rail  from  Florence,  Venice, 
Padua  and  Milan,  at  the  head  of  the  most  fertile  region 
of  Italy,  thickly  populated  by  a  prosperous  industrial 
race  ambitious  of  renewing  a  glorious  past,  the  pros- 
pects are  favorable  as  regards  this  prediction. 

When  a  city  so  highly  appreciates  the  noble  mission 
of  education,  it  is  natural  that  the  teaching  staff  should 


130  MODERN  ITALIAN  SURGERY 

include  the  greatest  representatives  of  every  branch  of 
study.  From  the  twelfth  century  on,  beside  the  leading 
study  of  law,  there  also  continued  to  flourish  at  Bologna 
those  studies  which  our  ancestors  fitly  called  liberal  arts 
and  humane  letters;  and  the  fame  of  the  university  also 
attracted  both  teachers  and  students  of  various  minor 
branches  of  knowledge  which  contribute  to  enrich  and 
ennoble  human  life.  And  thus  was  our  modern  idea  of  a 
university  developed  and  defined  at  Bologna  during  the 
thirteenth  century. 

With  historic  repetition,  in  a  new  age  of  marvellous 
development  built  upon  almost  irreparable  ruin,  the 
University  of  Bologna,  because  of  the  virility  of  her 
ancient  memories,  may  some  day  resume  the  civil 
jurisdiction  which  she  once  exercised.  If  so,  she  will 
resume  it  in  a  higher,  nobler,  and  purer  sense,  by  de- 
veloping for  the  benefit  of  every  nation  another  portion 
of  the  inheritance  of  ancient  Rome. 

Italy,  with  the  brains  of  her  beheaded  martyrs,  with 
the  books  of  her  philosophers  and  the  songs  of  her 
poets,  with  her  clever  diplomacy,  with  the  sword  of 
revolution,  and  with  the  artillery  of  her  army,  knocked 
persistently  at  the  gates  of  Rome  until  she  was  enthroned 
upon  the  Quirinal  and  the  Capitol. 

And  this  sacredness  of  daring  and  devotion,  unheard 
of  in  any  other  history,  has  rendered  her  worthy 
of  this — a  monarchical  republic,  with  monuments  of 
gratitude  to  Mazzini,  to  Cavour,  to  Victor  Emanuel,  II 
and  to  Garibaldi,  all  conspiring  with  a  common  object 
in  view — the  great  Italy  of  today. 

Hence  it  is  that  Bologna,  the  first  university  town  in 
the  world,  the  first  center  of  learning,  the  proud  jailer  of 


THE  UNIVERSITY  OF  BOLOGNA  131 

King  Enzo  (a  German  emperor),  the  possessor  of  the 
venerable  temple  of  San  Petronio,  which  was  reared 
in  memory  of  the  overthrow  of  the  domestic  tyranny 
of  the  Visconti,  the  cradle  of  so  many  patriots  and 
martyrs  of  the  Independence  of  Italy,  has  placed 
herself  courageously  and  energetically  at  the  head  of  a 
great  educational  movement  which  will  rival  her 
glorious  past. 


Chapter  XIII 
UNIVERSITIES  OF  MODENA  AND  PARMA 

LOOKING  over  the  map  of  the  Emilian  region, 
one  wonders  why,  at  such  a  short  distance  from 
Bologna,  there  should  be  two  other  universities 
like  Modena  and  Parma,  both  of  which  hold  an 
important  place  among  the  universities  of  Italy. 

The  reason  is  obvious.  When  the  little  principality 
of  Parma  and  Piacenza,  and  the  little  duchy  of  Modena, 
after  the  war  of  1859  between  Italy  and  Austria- 
Hungary  (which  gave  the  former  the  new  kingdom  of 
Lombardy),  decided,  by  popular  plebiscite,  to  be 
annexed  to  Italy,  the  new  government  inherited  the 
old  institutions  which  were  for  centuries  the  pride  of 
those  small  states. 

The  real  restoration  of  the  old  University  of  Modena 
to  a  progressive  institution  was  due  to  Duke  Francis 
11,  in  the  year  1678;  afterwards,  its  greatest  reputation 
was  achieved  with  the  famous  constitution  of  Francis  hi 
in  the  year  1772.  A  period  of  decadence  followed  until 
1887,  when  new  life  was  put  into  the  institution, 
placing  it  under  the  same  rules  and  regulations  as  the 
other  state  universities. 

At  present  a  very  distinguished  pathologist  and 
clinician,  Prof.  Mario  Donati  (pupil  of  Prof.  Antonio 
Carle  of  Turin)  is  the  director  of  the  surgical  clinic  of  the 
university.  A  very  active  and  prolific  scientist,  he  has 
produced  some  original  works  on  the  pathogenesis  of 
gastric  ulcer,  on  the  surgery  of  the  stomach,  and 
especially  on  ulcer  of  the  stomach,  the  last  receiving  the 

132 


UNIVERSITIES  OF  MODENA  AND  PARMA       133 

Zanetti  prize  at  Florence.  A  complete  study  which  he 
made  in  1901  on  the  blood  of  cancerous  people  was 
considered  one  of  the  best  monographs  of  the  time.  His 
contributions  to  the  surgery  of  the  kidney  and  esopha- 
gus, adding  some  valuable  modifications  to  endothoracic 
surgery,  and  on  the  intratracheal  technique  of  Meltzer 
and  Auer,  are  also  considered  very  important.  He 
published  some  experimental  studies  on  cystitis  from 
staphylococcus  and  renal  infection  (1907).  Original  are 
his  anatomic  studies  on  the  inguinal  canal  of  women  in 
relation  to  direct  inguinal  hernia,  as  are  those  on  tumors 
of  the  biliary  canal,  on  hypernephroma,  muscular 
angioma,  acute  vertebral  osteomyelitis,  malignant 
tumor  of  the  thyroid,  osteosarcoma  of  the  ovaries, 
coxa  vara  following  the  fracture  of  the  neck  of  the 
femur,  and  a  complete  study  of  the  thoracic  duct  from 
a  case,  throwing  light  on  the  surgery  of  that  organ  (19 14), 
etc.  He  is  completing  at  present  a  treatise  on  the 
surgery  of  the  abdomen,  partly  published  by  the  Typo- 
graphic Union  of  Turin. 

Professor  Donati  took  a  very  active  part  during  the 
war,  being  a  strong  partisan  of  immediate  intervention 
in  the  treatment  of  wounds,  with  instant  suture.  He 
obtained  splendid  results  in  his  cases,  especially  in 
cranioencephalic  and  articular  surgery.  Although  very 
young,  he  is  one  of  the  greatest  surgeons  of  Italy  and  is 
destined  to  a  splendid  career.  His  modern  spirit  and 
activity  are  wonderful.  He  is  planning  the  foundation 
of  The  Archives  oj  Surgery,  which  no  doubt  will  compete 
with  any  foreign  publication  of  its  kind. 

The  institute  of  surgical  pathology  is  at  present  di- 
rected by  Prof.  Paolo  Fiori  who  has  already  published 


134  MODERN  ITALIAN  SURGERY 

some  very  interesting  articles  on  the  pathology  of  the 
kidney. 

Modena,  the  ancient  "Mutina,"  is  a  quaint  little 
city  of  about  25,000  inhabitants,  very  prosperous, 
industrious  and  wealthy.  The  city  has  an  historical 
importance  which  is  attested  by  the  beautiful  Cathedral 
begun  under  the  domination  of  Countess  Matilda  of 
Tuscany  (1099),  the  ducal  palace  of  the  time  of  the 
domination  of  the  Estenses  family,  the  remnants  of  the 
French  invasion,  and  the  many  attractive  buildings  of 
modern  Italy. 

PARMA 

More  important  than  Modena  is  the  city  of  Parma, 
one  of  the  finest  cities  of  northern  Italy,  with  a  popu- 
lation of  about  50,000,  industrious  and  wealthy.  In  the 
center  of  the  city  the  Via  Aemilia  widens  out  into  the 
Piazza  Garibaldi,  adorned  by  the  Palazzo  del  Governo 
and  the  Palazzo  Municipale,  both  magnificent  struc- 
tures dating  from  1627.  Here  the  Cathedral  of  the 
Assumption,  consecrated  in  1106,  is  also  an  imposing 
monument,  full  of  artistic  and  precious  ornaments,  rare 
paintings  and  sculptures  of  the  Renaissance  period. 

Everywhere  the  domination  of  the  Farnese  family  is 
recalled  by  fine  palaces,  a  large  monumental  theater,  an 
academy  of  fine  arts  containing  some  precious  frescoes, 
the  famous  "Madonna  of  San  Gerolamo"  and  "Ma- 
donna Delia  Scodella"  of  Correggio.  Ranuccio  1,  of 
the  Farnese  family,  founded  the  university  in  1601 
with  the  faculties  of  law,  medicine  and  natural  sciences, 
an  observatory  and  a  very  interesting  and  rich  collection. 

In  i860,  Parma,  similar  to  Modena,  by  popular  plebis- 


UNIVERSITIES  OF  MODENA  AND  PARMA       135 

cite  was  annexed  to  the  kingdom  of  Italy,  and  its  institu- 
tions became  wards  of  the  government  of  new  Italy. 

The  University  of  Parma,  although  flourishing  in  the 
twelfth  and  thirteenth  centuries,  reached  the  height  of 
its  reputation  under  the  Farnese  family  (1545)  espe- 
cially when  Ranuccio  1  annexed  the  College  of  Nobles, 
a  shelter  for  300  scions  of  the  noblest  families  of 
Europe.  The  university  revived  under  Ferdinand  1 ,  the 
Bourbon,  and  again  in  the  Napoleonic  period,  but 
declined  at  the  beginning  of  the  last  century  until  its 
final  annexation  to  the  new  kingdom  of  Italy,  when  it 
began  to  flourish  again.  At  present  it  is  very  active. 

The  surgical  clinic  of  the  University  of  Parma  was 
under  the  direction  of  Prof.  Andrea  Ceccherelli  from 
1882  to  191 3,  when  this  highly  esteemed  and  able 
scientist  died,  leaving  a  large  contribution  to  surgical 
literature.  Editor  of  The  Surgical  Clinic,  one  of  the 
most  conspicuous  scientific  reviews  of  surgery  in  Italy, 
he  handled  every  subject  in  the  surgical  field  with  scien- 
tific skill  and  knowledge.  Well  known  is  his  special 
method  of  nephropexy  with  a  special  stitch  over  the  last 
rib,  and  his  own  method  of  hemostasis  of  the  liver. 

Ceccherelli  started  a  treatise  on  Italian  surgery,  with 
the  purpose  of  compiling  a  real  surgical  encyclopedia 
with  monographs  from  different  Italian  authors  on 
original  work.  This  treatise  was  interrupted  by  his 
death,  and  is  now  being  continued  by  his  successors.  At 
present  the  surgical  clinic  is  directed  by  Pi  of.  Giuseppe 
Tusini,  the  originator  and  director  of  the  Castrense 
University  of  San  Giorgio  di  Nogaro,  which  was  organ- 
ized near  the  battle  lines,  for  the  instruction  of  the 
enlisted  medical  students  during  the  war. 


136  MODERN  ITALIAN  SURGERY 

A  pupil  of  the  famous  Prof.  Antonio  Ceci  of  the 
University  of  Pisa,  Professor  Tusini  has  already  made 
a  name  for  himself  by  his  splendid  publications  on 
various  surgical  questions — "Varieties  of  Endotheliom- 
ata"  (1898);  "Actinomycosis  of  the  Foot"  (1900); 
"Tuberculosis  of  Certain  Ovarian  Tumors"  (1904); 
"Contribution  to  the  Study  of  Epithelial  Etherotopy," 
"Primitive  Alteration  of  the  Epithelium,"  and  "Carci- 
noma of  the  Intestine"  (1908).  He  has  several  articles  on 
"Visceral  Echinococcus,"  and  a  very  important  work 
on  "  Polioadenopathy,  Morbid  and  Chronic,  in  Hodg- 
kin's  Disease"  (1900).  During  the  period  between  1903 
and  1905,  he  published  a  study  on  "Solid  Tumors  from 
Embryonal  Inclusions  of  the  Large  Ligament,"  and  a 
study  on  "Infecting  Papilloma  of  the  Ovaries."  Several 
contributions  to  the  surgery  of  the  stomach  and  the 
brain  have  placed  Professor  Tusini  among  the  principal 
teachers  of  modern  surgery  in  Italy. 

Not  far  from  Parma  (about  thirty  miles),  situated 
among  the  foothills  of  the  Apennines,  is  Salsomaggiore, 
the  new  health  resort,  a  charming  little  town  of  1,200 
inhabitants.  The  waters  of  Salsomaggiore  are  the  richest 
in  the  world  in  iodine,  bromine,  strontium,  lithium  and 
sea  salt.  They  are  pumped  up  by  artesian  wells  (from  a 
depth  ranging  from  400  to  700  meters)  which  supply  the 
three  Stabilimenti  in  the  town  and  also  the  Grand  Hotel 
des  Thermes,  which  enjoys  the  unique  attraction  of 
enabling  its  visitors  to  take  their  baths  in  the  hotel 
itself,  each  floor  being  provided  with  special  bathrooms 
for  that  purpose,  in  addition  to  the  ordinary  ones. 

Beneficial  results  are  felt  at  once  in  all  cases  of 
rheumatism  and  gout,  rheumatoid  arthritis,  diseases  of 


UNIVERSITIES  OF  MODENA  AND  PARMA       137 

women,  anemia,  convalescence  after  long  illnesses, 
infantile  rachitis,  affections  of  the  nervous  system, 
neurasthenia  (by  bath  cure),  and  diseases  of  the 
respiratory  tract  (by  inhalation).  These  may  fairly  be 
termed  marvellous. 

The  resort  is  run  by  a  company  which  is  interested 
in  several  big  hotels  well  provided  with  all  the  comforts 
required  for  the  treatment  and  accomodation  of  the 
numerous  patients  who  patronize  the  famous  place. 
Medical  attendance  of  expert  physicians,  able  nurses 
and  fully  equipped  massage  and  electrical  devices  can 
be  obtained  in  the  place  during  the  season,  which  ex- 
tends from  early  spring  to  late  in  the  fall.  Salsomag- 
giore  has  a  well-deserved  world-wide  reputation. 


Chapter  XIV 
THE  UNIVERSITY  OF  PADUA 

IN  the  coming  year,  1922,  Padua  will  celebrate  the 
seven  hundredth  anniversary  of  its  university,  the 
foundation  of  which  was  said  to  be  a  sign  of 
rebellion  against  the  tyranny  of  Bologna,  which  had 
forbidden  its  teachers  to  lecture  outside  the  university. 
Padua  (ItaL,  Padoia)  is  an  ancient  city  in  the  north- 
east of  Italy  with  about  80,000  inhabitants,  lying  in  the 
center  of  a  thickly  populated  district,  rich  in  fertile 
land.  Its  origin  dates  from  the  Trojan  Antenor  and 
the  inhabitants  are  descendants  of  the  earliest  settlers 
of  the  Venetian  plains.  Abano,  only  ten  miles  distant, 
was  the  birth  place  of  Livy,  and  Padua,  that  of  many 
illustrious  Romans. 

The  city  is  crossed  by  the  Bacchiglione  River, 
spanned  by  many  monumental  bridges.  The  picturesque 
streets  are  lined  by  sumptuous  palaces  with  elegant 
arcades,  some  of  the  palaces  dating  from  the  year  1 172. 
The  Palazzo  della  Ragione  is  famous  for  an  immense  hall 
267  feet  long  by  89  broad  and  78  high,  standing  upon 
arches;  its  walls  are  covered  with  symbolical  paintings 
in  fresco.  This  unique  building  is  celebrated  throughout 
the  world  for  its  enormous  roof,  considered  an  archi- 
tectural wonder. 

The  history  of  Padua  is  very  interesting  because  of 
the  many  vicissitudes  it  experienced  from  the  time 
when  it  was  a  prosperous  Roman  city,  until  its  ruin 
brought  by  the  Huns  under  Attila  (452),  and  by  the 

138 


THE  UNIVERSITY  OF  PADUA  139 

Goths  under  Totila.  Following  the  course  of  many  other 
cities  of  northern  Italy,  the  city  fell  under  the  domi- 
nation of  the  Lombards,  the  Franks,  the  Bishops,  the 
Communes,  the  Despots,  the  Venetians,  and,  after  a 
long  period  of  Austrian  supremacy,  was  finally  united 
to  the  new  kingdom  of  Italy. 

At  present  it  is  a  prosperous  city,  having  developed 
a  great  many  industries.  Large  foundries,  chemical 
factories  and  laboratories,  distilleries,  breweries,  candle 
works,  ink  works,  agricultural  and  automobile  factories 
and  saw  mills  are  very  active,  and  the  trade  of  the 
district  has  grown  to  such  an  extent  that  Padua  has 
become  the  central  market  of  the  whole  of  Venetia. 

The  city  of  Padua  is  about  thirty-five  miles  west  of 
Venice,  and  double  that  distance  east  of  Verona,  with 
the  Friuli  at  the  northeast  and  the  Tyrol  at  the  north- 
west, being  almost  at  the  center  of  the  horseshoe,  which 
represented  the  great  amphitheater  of  the  Great  War. 

In  twenty  minutes,  by  rail,  from  Padua,  the  train 
reaches  Abano,  the  little  city  mentioned  above  as  the 
birthplace  of  Livy,  renowned  for  its  mud  baths  and 
medicinal  waters  efficacious  in  skin  diseases,  gout  and 
rheumatism.  The  city  is  famous  as  a  watering  place, 
long  known  to  the  Romans.  The  quaint  little  city  lies 
at  the  foot  of  the  Euganean  Hills  where  Francesco 
Petrarca,  the  poet  of  love,  is  buried  and  where  tourists 
can  always  find  beautiful  spots  for  pleasant  excursions. 
There  are  eight  large  establishments  in  the  place  for  the 
accommodation  of  the  numerous  patients,  and  some 
comfortable  hotels,  well  patronized  by  natives  and 
foreign   visitors   seeking   relief  for   their   ailments. 

Eighty  miles  northwest  of  Padua,  there  is  another 


140  MODERN  ITALIAN  SURGERY 

health  resort,  the  famous  spring  of  Recoaro,  surround- 
ed by  the  Tyrolian  Dolomites  in  a  beautiful  spot 
near  the  end  of  Val  d'Agno.  The  waters  are  known  for 
their  virtue  in  any  ailment  where  iron  is  required  to 
build  up  a  weakened  constitution,  to  restore  strength 
to  convalescents  from  long  and  serious  illnesses. 
A  large  establishment,  built  by  the  Government,  and 
several  private  and  up-to-date  hotels,  can  accomodate 
the  numerous  clientele  which  patronizes  the  place. 

Padua's  churches,  museums  and  galleries  are  full  of 
art  treasures.  The  most  famous  of  its  churches  is 
the  Basilica,  dedicated  to  the  great  St.  Anthony, 
who  has  been  a  sacred  subject  for  a  multitude  of 
artists.  Nicola  Pisano  designed  the  church,  and  Sanso- 
vino,  with  Falconetto,  ornamented  it.  In  front  stands 
the  colossal  equestrian  statue  of  Gattamelata  (Erasmo 
da  Narni),  General  of  the  Army  of  the  Republic  of 
Venice  (i 438-1441),  by  Donatello.  This  statue  is  the 
first  great  specimen  of  bronze  casting  of  the  modern 
Italian  period  of  art.  A  plaster  copy  can  be  seen  in  the 
Metropolitan  Museum,  New  York. 

The  library,  the  archives,  the  Pinacotheca  are  also 
full  of  old  paintings,  statuary,  and  rare  treasures  of 
art,  among  which  are  some  works  of  Giotto,  Paolo 
Veronese,  Tiepolo,  Garofalo,  Morone,  Titian,  Boccaccino 
and  many  other  famous  artists. 

The  university,  for  which  Padua  has  been  and  is 
famous,  was  founded  by  Frederick  11  in  1238,  and 
afterward,  under  Venice,  was  governed  by  three 
patricians  called  "Riformatori  dello  Studio." 

A  sarcophagus  containing  the  body  of  the  Trojan 
Antenor  (who,  according  to  Virgil,  was  the  founder  of 


THE  UNIVERSITY  OF  PADUA  141 

Padua)  stands  before  the  university  building;  inside  the 
building  is  a  court  surrounded  by  some  handsome 
colonnades  by  Sansovino,  erected  in  1552,  engraved 
with  the  names  of  many  distinguished  Cives  Academici. 
Galileo  Galilei  taught  there  for  ten  years,  and  there  also 
lectured  the  great  Vesalius,  Fabricius  ab  Aquapendente, 
Bembo,  Scaliger,  Tasso,  Sobieski,  and  here  studied  for 
many  years,  under  Fabricius,  William  Harvey,  who, 
from  the  work  of  his  masters,  published  the  first  descrip- 
tion of  the  circulation  of  the  blood,  the  discovery  being 
afterwards  attributed  to  him.  (In  the  archives  of  Padua 
and  Bologna  are  preserved  the  original  works  of  Silvius, 
Servetus,  Vesalius  and  Cesalpino  on  the  subject,  which 
give  to  Harvey  the  honor  of  the  description.1) 

At  present  the  University  of  Padua  is  the  center  of 
study  for  the  Venetian  provinces,  and  its  surgical 
clinic  is  familiar  through  the  popular  name  of  Edoardo 
Bassini,  whose  method  of  operation  in  cases  of  inguinal 
hernia,  is  well  known  to  every  student.  His  technique  is 
based  on  the  anatomy  of  the  inguinal  canal,  and  the 
utilization  of  its  tissues  for  its  reconstruction. 

Professor  Bassini,  by  reason  of  his  advanced  age,  has 
been  retired  and  honored  as  emeritus  for  his  extensive 
work  as  a  teacher  of  surgery  and  for  his  many  original 
publications  on  almost  every  subject  of  scientific  and 
practical  surgery.  His  period  of  professorship  has  been 
one  of  the  longest,  having  succeeded  the  famous 
Professor  Vanzetti  who  was  called  to  the  University  of 
Kharkoff  (Russia)  as  professor  of  clinical  surgery. 

Professor  Bassini's  contribution  to  surgical  literature 

1Sir  Michael  Foster.  Lectures  on  the  History  of  Physiology.  Cambridge, 
At  the  University  Press,  1901. 


i42  MODERN  ITALIAN  SURGERY 

is  very  large.  His  masterly  descriptions  of  the  "  Inter- 
scapulothoracic  Amputation  for  Humeroscapular  Sar- 
coma," of  "Nephropexy"  and  "Ileocecal  Resection," 
when  such  operations  were  only  in  their  experimental 
period,  are  well  known  among  the  surgical  profession, 
and  rank  him  as  one  of  the  foremost  of  modern  surgeons. 
His  retirement  from  the  chair  of  surgery  is  deeply 
regretted  by  a  great  many  of  his  pupils  and  admirers. 

The  chair  of  surgical  pathology  is  held  with  great 
honor  by  a  pupil  of  the  University  of  Rome,  Prof. 
Demetrio  Roncali,  who  wrote  one  of  the  largest  and 
most  original  works  on  malignant  tumors.  His  publica- 
tion has  been  very  much  discussed  and  criticized  by  the 
scientific  world,  on  account  of  the  importance  he 
attributes  to  the  relation  and  connection  of  the  blasto- 
mycetes  and  the  malignant  neo-formations  found  in  the 
histological  study  of  those  neoplasms. 

The  isolation  of  the  ferments  of  the  malignant  neo- 
plasms of  the  human  body,  opened  up  the  study  of  the  bio- 
logical, morphological  and  pathogenical  characteristics 
of  such  a  microorganism,  with  the  positive  outcome 
from  the  inoculation  in  animals.  Partisan  of  the  blasto- 
mycetic  theory,  started  and  evolved  in  Italy  (especially 
after  the  investigations  of  Maffucci,  Sirleo,  San 
Felice),  Roncali  believes  that  the  malignant  tumor 
ought  to  be  considered  as  a  product  of  infection  and 
inflammation,  and  the  etiology  of  carcinoma  as  a 
manifold  parasitic  and  toxinic  process. 

Roncali  has  also  published  some  interesting  studies 
on  the  pathology  of  the  nervous  system,  on  brain 
operations  and  on  a  new  technique  for  laminectomy. 

The  surgical  department  of  the  University  of  Padua 


Prof.  Edoardo  Bassini,  Padua. 


THE  UNIVERSITY  OF  PADUA  143 

has  a  staff  of  young  teachers  who  have  distinguished 
themselves  on  account  of  important  work  and  publica- 
tions on  various  subjects.  Giovanni  Velo  has  published 
some  original  notes  on  pyloric  stricture  with  a  technique 
of  combined  divulsion,  and  a  special  process  for  the 
resection  of  the  astragalus.  Special  observations  of 
Saverio  Spangaro  on  the  results  of  the  ligature  of  the 
vas  deferens  are  very  important,  as  are  those  of  Ugo 
Dall'Acqua  on  varicose  veins. 

Supported  by  the  Government  and  by  special  endow- 
ments, the  University  of  Padua  has  made  notable 
progress.  There  are  at  present  several  new  buildings 
in  course  of  construction,  intended  for  scientific  labora- 
tories. The  university  has  over  one  hundred  so-called 
"Scholarships"  for  poor  students  and  undergraduates, 
partly  provided  by  the  Government  and  partly  by 
private  endowments. 


Chapter  XV 
THE  UNIVERSITY  OF  PAVIA 

FOR  fifteen  centuries  the  history  of  Pavia  has 
been  identified  with  that  of  the  northern 
half  of  Italy.  Its  location  at  the  junction  of 
the  two  largest  waterways  of  the  plain  of 
Lombardy — the  rivers  Ticino  and  Po — made  it,  from 
the  earliest  ages,  the  most  important  city  of  the  region 
for  strategic,  political,  and  commercial  reasons.  Yet, 
this  city,  the  Ticinum  of  Imperial  Rome,  the  royal 
residence  of  Theodoric  the  Great;  "Papia,"  the  illus- 
trious capital  from  which  the  Lombard  dynasties  ruled 
northern  Italy;  afterward  the  capital  of  the  Ghilbelline 
party,  of  the  royal  Fredericks  and  of  Henry  vii;  the 
strong,  the  formidable  fortress  of  the  Visconti  and 
Sforza  tyrannies  of  more  recent  date,  has  left  behind 
not  one  worthy  monument.  This  ancient  metropolis  of 
marble  palaces,  this  medieval  stronghold  of  a  hundred 
towers,  has  sunk  into  a  little,  sleeping  provincial  town, 
with  dark,  monotonous  streets  and  ugly  buildings, 
inhabited  by  a  population  of  only  30,000  souls. 

In  spite  of  all  this,  there  is,  in  the  tragic  evolution 
of  the  wonderful  history  of  Pavia,  so  much  to  be  learned, 
thatf  every  fragment,  every  stone,  surviving  from  those 
great  epochs,  fascinates  the  imagination  of  the  most 
apathetic  visitor. 

The  remains  of  the  Visconti  Castle,  the  classic  quad- 
rangles of  the  university,  for  so  many  ages  the  seat  and 

center  of  Lombard  learning,  still  vibrate  with  the  un- 

144 


THE  UNIVERSITY  OF  PAVIA  145 

dying  words  of  Volta  and  Spallanzani.  Imperial  Rome 
still  lives  in  its  even  rectangularity  of  narrow  streets, 
and  their  somber  architecture  still  bears  the  brutal 
imprints  of  the  conquering  Lombards. 

With  the  domination  of  Theodoric  the  Great,  we 
associate  the  tragic  end  of  Boethius,  the  author  of  the 
"Consolation  of  Philosophy,"  written  in  a  prison  (one 
of  the  hundred  towers  of  Pavia),  whose  site  is  still 
pointed  out. 

Pavia  suffered  all  the  vicissitudes  of  invasion,  war, 
and  destruction,  but  remained  always  a  center  of  learn- 
ing and  study.  And  of  these,  the  best  patrons  were  often 
those  despots  who  have  ruled  with  iron  hands.  To 
Gian  Galeazzo  Visconti  and  afterward  to  Lodovico 
Sforza  is  due  the  foundation  of  the  famous  Certosa, 
built  only  a  few  miles  from  Pavia  in  the  wilderness. 
This  most  interesting  and  magnificent  of  Italian 
churches  and  monasteries,  this  temple  so  great,  so 
minute  in  detail,  so  brilliant,  was  commenced  in  the 
fourteenth  century.  The  artists  were  still  working  at  it 
in  the  eighteenth  century.  Yet  the  labor  of  four 
hundred  years  scarcely  accounts  for  the  immensity  of 
its  collections  of  sculptures,  carved  decorations,  works 
of  gold,  bronze,  ivory,  ebony,  precious  stones,  mosaics, 
frescoes  and  paintings,  and  the  wealth  of  art  that  goes 
with  it. 

During  the  twenty  years'  reign  of  Lodovico  Sforza, 

surnamed  II  Moro  (the  Moor),  a  great  many  important 

works  were  added  to  the  already  beautiful  church  and 

monastery,  and  the  most  celebrated  artists  of  the  time 

were  employed.  In  all  the  great  work  that  Lodovico 

did  for  Certosa  and  for  Pavia,  he  was  constantly  advised 
10 


i46  MODERN  ITALIAN  SURGERY 

and  supported  by  his  beautiful  wife,  Beatrice  D'Este, 
one  of  the  most  remarkable  women  of  her  time,  who  died 
very  young  and  fatally  took  with  her  the  fortune  of  her 
husband,  who  lost  his  genius,  his  power  and  his  liberty. 

But  this  is  not  the  place  to  recount  the  glory  and  the 
fall  of  Pa  via  in  the  past;  the  city  of  today  is  a  prosperous 
community  of  about  30,000  inhabitants,  very  peaceful 
and  industrious. 

The  University  of  Pavia  naturally  had  its  ups  and 
downs  with  the  political  vicissitudes  of  so  many  cen- 
turies of  invasion,  war,  destruction  and  reconstruction, 
until  the  final  barbarous  pillage  of  the  French  army 
under  Lautrec,  in  1527,  from  which  the  city  never 
recovered,  devastated  the  country.  But,  though  the 
country  and  the  city  did  not  recover  their  previous 
splendor,  the  seat  of  learning  remained. 

The  university  was  founded  by  Charles  rv,  licensed  by 
Pope  Boniface  ix,  endowed  by  Charlemagne,  again  very 
liberally  by  Gian  Galeazzo  Visconti  and  the  munificent 
Lodovico,  who  raised  it  to  its  early  pinnacle  of  greatness. 
After  the  ruin  of  the  Spanish  era,  it  was  revived  by 
Maria  Theresa,  who  placed  in  it  the  splendid  new  build- 
ings that  exist  still,  and  started  it  upon  a  new  prosperity. 

It  remained  for  Napoleon  to  imitate  Lodovico  and 
crown  the  university  with  a  second  climax  of  aggrand- 
izement, making  it  the  object  of  the  munificent  support 
of  the  Government.  This  status  modern  Italy  has 
maintained,  not  quite  equal  to  the  Sforza  days,  when 
it  had  3,000  students,  and  ninety  professors,  but  still 
the  fourth  foremost  university  in  Italy,  with  its  huge 
library  of  200,000  volumes  and  important  collections 
covering  nearly  every  branch  of  science  and  art.  It 


THE  UNIVERSITY  OF  PAVIA  147 

had  its  splendor  in  the  fifteenth  century  when  the  St. 
Matteo  Hospital  was  founded,  and  in  the  sixteenth 
century  when  Carcano,  Alciato  and  Leone  G.  B.  Carcano 
taught,  and  the  two  colleges  of  Ghisilieri  and  Borromeo 
were  founded  by  endowment,  one  with  eighty  and  the 
other  with  thirty  scholarships.  The  endowment  institu- 
tions of  Pope  Pius  v  (Ghisilieri)  and  Cardinal  Borromeo 
(Borromeo)  have  been  working  in  perfect  order  since 
their  foundation. 

The  fame  of  the  medical  school  of  Pavia  is  indirectly 
associated  with  the  name  of  Alessandro  Volta,  but  more 
directly  with  that  of  Antonio  Porta,  one  of  the  greatest 
anatomists  and  surgeons  of  the  last  century.  Porta  was 
succeeded  by  another  great  surgeon  and  eminent 
pathologist,  Prof.  Enrico  Bottini,  one  of  the  most 
audacious  and  perfect  technicians  of  his  time,  and  the 
surgeon  who  initiated  the  use  of  carbolic-acid  solutions 
in  operations  long  before  Lister  ever  mentioned  it. 

Bottini's  first  volume  on  the  surgery  of  the  neck, 
his  numerous  operations  on  the  thyroid  gland,  many 
publications  on  Iaryngotomy  and  laryngectomy,  and  the 
application  of  an  artificial  larynx  gained  for  him  a  world 
reputation,  while  a  careful  study  of  the  prostatic  gland 
and  its  pathological  growth  and  the  ingenious  surgical 
treatment  with  special  instruments  (prostatic  thermo- 
cautery) gave  his  name  to  a  method  which  had  for 
a  long  time  remarkable  success.  This  method  was 
quite  popular  in  the  various  urological  clinics  of  Europe, 
and  was  introduced  in  America  by  one  of  the  most  skill- 
ful surgeons  of  New  York  (Willy  Meyer).  Enrico  Bottini 
left  a  name  as  a  great  surgeon,  a  valuable  pathological 
collection,  and  a  pupil  fully  worthy  of  his  great  teacher. 


148  MODERN  ITALIAN  SURGERY 

Prof.  Iginfo  Tansini,  the  distinguished  successor  of 
Enrico  Bottini,  was  for  some  years  director  of  the 
surgical  clinic  of  the  University  of  Palermo;  he  belongs 
to  that  throng  of  eminent  Italian  surgeons  who  have 
brought  Italian  surgery  to  so  exalted  a  position.  It  is 
almost  impossible  to  give  here  a  synopsis  of  the  numer- 
ous original  works  of  Tansini,  not  only  along  surgical 
lines,  but  also  in  anatomy  and  physiology  in  their 
relation  to  surgery.  The  following  publications  are 
worthy  of  mention:  "The  Most  Important  Anatomical 
Anomalies  in  Regard  to  Operative  Surgery,"  "Con- 
tributions to  the  Study  of  Congenital  Goiter,"  "The 
Experimental  Researches  on  the  Isolation  of  the 
Intestine  From  the  Mesenterium,,,  "The  Study  of 
Cardiac  Impulse  After  the  Opening  of  the  Chest," 
and  contributions  to  intestinal  and  renal  surgery. 

Tansini  was  the  first  surgeon  in  Italy  to  perform 
successfully  the  pylorogastric  resection  for  cancer 
(1887),  anQT  tne  partial  resection  of  the  liver.  In  1902  he 
combined  splenectomy  with  Talma's  operation  in 
Banti's  disease,  and  later  (1909)  performed  the  same 
operation  in  a  case  of  thrombotic  splenomegaly  with 
hepatocirrhosis  in  a  patient  suffering  from  ascites. 
In  the  same  year,  he  published  statistics  of  47  nephrec- 
tomies, marred  by  only  one  death,  thanks  to  his  special 
method.  In  1914  he  published  a  paper  showing  the 
results  of  surgical  treatment  in  14  cases  of  gastroptosis. 

After  long  and  careful  observations,  Tansini  empha- 
sized as  an  important  diagnostic  sign,  in  cases  of  pyloric 
cancer,  the  fact  that  the  abdomen  is  larger  and  ascitic 
when  there  is  a  metastasis,  while,  if  the  cancer  is 
localized  and  there  is  not  a  metastasis,  the  abdomen 


THE  UNIVERSITY  OF  PAVIA  149 

is  very  flat  and  there  is  no  ascites — a  very  important 
point  in  considering  the  advisability  of  an  operation. 

Tansini  proposed  the  cauterization  of  nervous  stumps 
in  peripheric  neurectomies,  especially  facial,  for  neural- 
gia, claiming  permanent  success.  He  also  proposed  and 
described  the  insertion  of  the  portal  vein  in  the  vena 
cava,  with  a  special  method  of  terminal-lateral  anasto- 
mosis of  the  portal  stump  in  that  tract  of  the  cava 
which  intercedes  between  the  emulgent  and  spermatic 
veins.  This  proposal  was  sanctioned  in  the  Clinic  by  a 
case  operated  by  Vidal,  for  the  purpose  of  deviating  the 
portal  blood  into  the  cava,  in  an  obstructed  portal 
circulating  system. 

Well  known  also  is  the  method  of  Tansini  for  the 
amputation  of  the  cancerous  breast,  in  which,  after 
amply  removing  the  diseased  part  including  the  sur- 
rounding tissues,  he  takes  a  sufficient  cutaneous  mus- 
cular flap  from  the  subspinal  region.  With  this  large 
healthy  flap  he  covers  the  wound  with  loose  stitches  for 
a  first  intention  healing,  making  it  safe  against  the 
cutaneous  recidivation  which  is  so  frequent  in  those 
cases,  especially  when  the  flap  from  the  subaxilla  is 
tightly  stretched.  With  his  method,  the  soft  pillow-like 
flap,  obtained  without  impairing  the  free  movements  of 
the  scapula  and  the  humeral  articulation,  leaves  a  soft, 
comfortable  and  painless  scar. 

The  chair  of  surgical  pathology  of  the  University  of 
Pavia  is  held  by  a  pupil  of  Professor  Durante  of  Rome, 
the  distinguished  Prof.  Giovanni  Perez,  who  is  the 
author  of  some  very  interesting  articles  on  surgery: 
"Surgical  Complications  From  the  Bacillus  Influenzae," 
"Staphylococcemia,  Pyemic  Type,  Without  Metastasis," 


150  MODERN  ITALIAN  SURGERY 

"Surgical  Treatment  of  Nephritis,"  "Splenectomy," 
"A  Study  of  Bone  Cysts."  Recently  he  published  a 
very  interesting  contribution  to  the  surgery  of  the  war 
for  the  benefit  of  young  surgeons  and  students. 

For  many  years  the  name  of  Carlo  Forlanini,  who  was 
professor  of  clinical  medicine  at  the  University  of  Pavia, 
has  been  popular  in  the  medical  scientific  world  on 
account  of  his  studies  and  discoveries  in  the  surgery  of 
the  chest  and  the  treatment  of  pleural  and  pulmonary 
diseases.  Forlanini's  death  was  a  great  loss  to  the 
profession  and  to  the  medical  school  at  Pavia,  where  he 
left  many  distinguished  pupils. 

One  of  them,  assistant  to  the  medical  clinic,  Eugenio 
Morelli,  free  docent  in  special  medical  pathology  and 
clinical  medicine,  following  in  the  footsteps  of  his  great 
teacher,  published  during  the  war,  while  he  was  director 
of  a  field  hospital  at  the  front,  a  very  remarkable 
work:  "The  Treatment  of  the  Wounds  of  the  Lungs 
With  Artificial  Pneumothorax."  This  work,  published  in 
a  moment  of  such  urgent  necessity,  attracted  at  once 
the  interest  of  the  military  and  civil  surgeons,  who  soon 
adopted  his  method  and  his  instruments  to  stay  the 
threatening  hemorrhage  of  the  lungs  and  the  impending 
danger  to  the  injured  pleural  cavity. 

It  would  be  too  great  a  task  to  translate  Professor 
Morelli's  interesting  lecture,  which  was  read  on  January 
3,  191 7  near  the  front,  when  the  struggle  of  the  Italian 
army  was  most  intense.  This  was  published  by  Army 
Command.1  After  stating  how  high  is  the  percentage  of 
mortality  in  wounds  of  the  lungs,  especially  in  the 
immediate  front  line,  because  of  lack  of  care,  he  gives 

1Enrico  Voshera,  Rome,  19 17. 


THE  UNIVERSITY  OF  PAVIA  151 

statistics  showing  death  in  25  per  cent  of  the  cases 
in  the  first  line  hospitals,  because  the  practice  of  no 
intervention  was  considered  more  prudent. 

The  invariable  result  of  a  lung  wound  is  hemothorax, 
which  may  be  rapidly  fatal,  or  in  the  form  of  a  gradual 
leak  for  days.  This  is  due  to  the  great  vascularity  of  the 
lungs  and  to  the  continual  moving  of  the  organ  in 
performing  its  respiratory  functions,  and,  also,  because 
the  negative  pressure  of  the  pleura  acts  as  a  suction 
pump.  To  arrest  the  hemorrhage,  the  lung  has  to  be 
immobilized  and  the  suction  action  of  the  pleura 
stopped,  to  prevent  the  forming  of  an  empyema  by 
a  prompt  evacuation  of  the  blood.  The  danger  of  an 
infection  is,  of  course,  increased  by  the  blood  as  a 
culture  field.  The  danger  of  pleural  adhesions  would 
also  be  increased  by  permitting  the  blood  to  remain  in 
the  lung,  which  would  impair  function  of  the  respira- 
tion in  the  future  and  retard  healing.  Often  the  blood 
is  absorbed  very  slowly;  on  the  other  hand,  the  blood 
may  be  absorbed  rapidly  before  the  wound  is  healed, 
and  by  a  sudden  dilatation  of  the  lung  another  hemor- 
rhage may  be  threatened,  a  danger  which  may  also 
arise  from  a  rapid  absorption  of  the  spontaneous 
pneumothorax. 

Morelli  contradicts  the  opinion  that  the  blood  may 
be  left  as  a  compressor  of  the  lung,  observing  that  the 
liquids  are  not  liable  to  a  proper  distention  and  in 
consequence  not  adapted  to  the  immobilization  of  the 
lung.  The  usual  thoracentesis  with  Potain's  aspirator 
is  very  dangerous,  as  it  favors  the  tearing  of  the  lung 
with  a  consequent  new  hemorrhage. 

Morelli  has  invented  a  very  simple  instrument  with 


i52  MODERN  ITALIAN  SURGERY 

which  the  thoracentesis  can  easily  be  made.  This  allows 
the  substitution  of  the  gas  to  the  blood,  producing 
a  pneumothorax  instead  of  a  hemothorax,  thus  avoiding 
the  dangers  of  a  hemothorax  while  keeping  the  lung 
compressed  by  a  constant  refilling  of  the  cavity  as  is 
done  in  therapeutic  pneumothorax  in  cases  of  tubercu- 
losis of  the  lung  (Forlanini).  In  case  of  wounds,  the  lung 
can  be  compressed  by  sterile  air  and  the  compression 
maintained  for  three  or  four  weeks. 

Morelli  applied  this  method  in  many  cases;  in  40 
cases  of  immediate  intervention  recovery  resulted  in 
about  four  weeks.  Usually  only  light  pressure  is  required 
to  obtain  the  arrest  of  the  pulmonary  hemorrhage, 
and  the  procedure  is  very  simple  and  safe. 

Morelli  asserts  that  in  every  case  of  wound  of  the 
lung,  it  is  better  to  encourage  the  formation  of  the 
pneumothorax,  for,  with  the  compression  of  the  lung 
and  the  elimination  of  the  pleuritic  air  suction,  the 
hemorrhage  is  controlled.  It  must  be  borne  in  mind 
that  if  a  thoracic  wound  is  left  open,  such  intervention  is 
not  possible. 

Morelli  also  presented  and  described  an  instrument 
for  the  evacuation  of  a  pyothorax  and  the  irrigation 
of  the  pleura  while  maintaining  the  lung  compressed.1 

Before  closing  this  brief  article  on  the  University  of 
Pavia,  mention  must  be  made  of  some  of  the  men 
already  familiar  to  the  scientific  world,  like  Camillo 
Golgi,  professor  of  histology  and  general  pathology, 
who  is  celebrated  for  his  important  work  and  dis- 
coveries in  nerve  cells  and  corpuscles,  in  chromo- 
argentic  reaction  on  nerve  cells,  and  for  his  Nobel 

*J.  de  med  et  cbir.  prat.,  Par.  203. 


THE  UNIVERSITY  OF  PAVIA  153 

prize,  received  in  1906;  and  Scipione  Riva-Rocci,  pro- 
fessor of  pediatrics  and  special  medical  pathology, 
who  is  well  known  for  his  studies  on  blood  pressure 
and  is  the  inventor  of  a  well-known  instrument  for  that 
purpose.  These  men  are  a  credit  to  the  flourishing  school 
of  medicine  and  surgery  at  Pavia. 


Chapter  XVI 

SCIENTIFIC   INSTITUTES   OF  LEARNING   IN 

MILAN 

MILAN,  the  capital  city  of  Lombardy ,  like  Flor- 
ence, the  capital  city  of  Tuscany,  has  no  uni- 
versity. Like  Florence,  which  received  Pisa 
and  Siena  as  an  inheritance  and  a  tradition  of 
the  past,  Milan  received  Pavia  as  an  inheritance  and 
traditions  of  centuries  of  glorious  history  which  could 
not  be  effaced  or  forgotten.  And  so  it  is,  that  the 
splendid  Ticinum  of  Imperial  Rome,  the  royal  resi- 
dence of  Theodoric  the  Great,  the  magnificent  "Papia" 
of  the  Lombard  dynasties,  the  city  of  one  hundred 
towers  of  stately  palaces  and  gorgeous  churches,  the 
seat  of  the  most  sumptuous  courts  of  many  kings 
and  emperors,  the  coveted  prey  of  barbarians,  the 
field  of  terrible  battles,  of  slaughters  and  devastations, 
reduced  from  the  princely  city  of  the  Viscontis  and  the 
Sforzas  to  a  small  provincial  town  of  mediocre  import- 
ance, maintains  the  only  heraldry  left  to  the  pride  of  a 
fallen  dominion.  Reverence  for  such  traditions  and 
homage  to  the  illustrious  men  who  kept  high  and 
honored  the  glorious  name  of  that  university,  prevented 
intellectual  Milan  from  destroying  the  only  pride  left 
to  the  great  city  of  the  past. 

But  if  Milan  has  no  university,  it  has  something  very 
similiar  in  "Gli  Istituti  Clinici  di  Perfezionamento,', 
which  have  grown  with  the  wonderful  growth  of  the 
great  city.  It  could  not  be  otherwise,  for  Milan,  today, 
represents  the  intellectual,  commercial  and  industrial 

154 


INSTITUTES  OF  LEARNING  IN  MILAN  155 

center  of  Italy,  while  Pavia,  although  only  twenty-two 
miles  away  and  connected  with  the  big  city  by  excellent 
roads  and  the  famous  canal,  is  only  a  small,  industrial 
and  agricultural  town. 

The  idea  of  having  in  Milan  some  institutes  for  the 
purpose  of  coupling  scientific  studies  with  practical 
application,  had  been  ventilated  many  years  ago, 
especially  in  regard  to  the  medical  profession.  The 
annals  of  the  Ospedale  Maggiore  mention  a  course  of 
surgical  lessons  delivered  by  Cristoforo  Inzago  in  1634, 
followed  by  Felice  Calvi  in  1687,  when  a  regular  school 
of  surgical  anatomy  was  founded  by  the  board  of 
directors  of  the  Ospedale  Maggiore  with  the  following 
announcement: 

Considering  that  the  practical  teaching  of  medicine  and  surgery 
is  based  on  the  exact  knowledge  of  the  human  body,  and  that  such 
knowledge  cannot  be  acquired  in  the  brief  time  of  the  University's 
studies,  the  board  of  directors  of  the  Ospedale  Maggiore,  taking 
advantage  of  the  large  quantity  of  human  bodies  of  which  it  can 
dispose,  has  decided  to  open  a  course  of  anatomy  applied  to 
surgery. 

Following  is  a  list  of  names  of  the  teachers  who  held 
the  chair  of  anatomy  applied  to  surgery  at  the  Ospedale 
Maggiore  of  Milan : 

Antonio  Carnelli  (1687-88);  Battista  Ribotti  (1688-99);  Paolo 
Gerolamo  Biumi  (1699- 1724);  Alessandro  Sacco  (1724)  and  again 
Biumi  (till  1728);  Gaetano  Canavesi  (1728-34);  Girolamo  Crivelli 
(I734~42);  Giovanni  Battista  Senna  (1742-47);  Guglielmo  Patrini 
(1747- 1 786).  After  1790  the  surgical  school  was  under  the 
leadership  of  a  famous  anatomist,  Giovanni  Battista  Monteggia 
and  the  surgical  clinic  under  another  famous  man,  Gaetano  Strambio 
(1806). 


156  MODERN  ITALIAN  SURGERY 

But  the  fall  of  Napoleon,  brought  back  the  Austrians, 
who  destroyed  all  the  good  work  and  steady  progress 
under  Professors  Palletta,  Monteggia,  Rasori,  Strambio 
and  many  other  well-remembered  teachers. 

From  the  time  of  the  restoration  of  the  Austro- 
Hungarian  Government  ( 1 8 1 8)  to  that  of  the  liberation 
of  Lombardy  and  its  union  to  the  new  Italy  (1859), 
nothing  had  been  done  for  the  surgical  progress  of 
the  Ospedale  Maggiore,  and  not  until  the  political 
administration  of  the  new  government  of  Italy  was  well 
settled,  was  it  possible  to  resume  the  interrupted  work. 

Ten  years  later  (1869)  the  school  of  anatomy  was 
reorganized  under  Professor  Albertini,  and  soon  after 
several  prominent  professional  men,  among  whom 
were  Gaetano  Strambio,  mentioned  above,  Malachia  de 
Cristoforis,  Gaetano  Pini,  Pietro  Panzeri,  Edoardo 
Porro,  Andrea  Verga,  were  called  upon  to  advise  the 
proper  means  for  a  permanent  consolidation  of  the 
Istituti  Clinici  di  Perfezionamento. 

A  large  endowment  from  Siro  Valerio,  a  wealthy 
philanthropist,  started  a  new  era  of  activity  among 
the  most  prominent  professional  men  of  Milan,  headed 
by  a  very  energetic  and  ambitious  leader,  Prof.  Luigi 
Mangiagalli.  After  careful  consideration  a  plan  was 
completed  by  a  special  committee  selected  by  the 
municipal  board,  which  in  1901  laid  the  foundation  of 
the  "  Scientific  Institute  for  Study  in  the  City  of  Milan." 
From  that  time,  thanks  to  the  large  and  numerous 
endowments,  dates  the  rapid  growth  of  the  branch, 
Istituti  Clinici  di  Perfezionamento,  which  for  equipment 
and  efficiency  are  at  present  second  to  none  in  the  world. 

The  Istituti  Clinici  di  Perfezionamento  started  by 


INSTITUTES  OF  LEARNING  IN  MILAN  157 

improving  the  obstetric  and  gynecologic  institute, 
which  had  been  in  operation  for  many  years  and  was 
supported  by  special  endowments  from  the  city  and  by 
private  gifts.  Attention  was  next  directed  to  the  institute 
for  cripples  of  which  mention  has  been  made  in  the  spe- 
cial article — "  Institutes  for  Crippled  Children  in  Italy." 
A  remarkable  branch  of  the  Istituti  Clinici  di  Perfe- 
zionamento  is  the  well  known  clinic  for  occupational 
diseases,  which  was  planned  and  founded  by  the  Labor 
Party  of  the  municipal  board,  the  head  of  which  (then 
Mayor  Mussi),  at  the  inaugural  speech,  said: 

This  clinic  will  be  especially  devoted  to  the  study  of  occu- 
pational diseases,  familiarizing  practicing  physicians  with  the 
subject.  It  will  shelter  for  diagnostic  and  therapeutic  purposes 
the  workingmen  under  observation  for  suspected  infirmity,  or 
those  already  afflicted  by  some  occupational  disease,  so  as  to 
keep  under  control  the  health  condition  of  all  the  workingmen 
employed  in  the  various  industries,  and  especially  those  working 
under  insanitary  conditions. 

It  is  with  pleasure  that  we  take  from  the  Survey1 
an  article  written  by  John  B.  Andrews,  secretary  of  the 
American  Association  for  Labor  Legislation : 

Some  of  us  had  hoped  that  industrial  America,  with  its  wonderful 
resources,  its  famed  philanthropies,  and  its  uncounted  thousands 
of  work-diseased  men  and  women,  might  be  first  among  nations 
to  recognize  the  need  of  a  special  hospital  and  clinic  for  industrial 
diseases  .    .    .But  the  honor  belongs  to  Italy. 

Eight  years  ago  a  group  of  social-minded  medical  men  in  Milan, 
united  in  a  demand  for  systematic  study  of  diseases  of  occupation. 

Four  years  ago  they  called  together  from  many  nations,  the 
first  International  Congress  of  Industrial  Diseases;  last  March  they 
saw  the  hopes  of  years  culminate  in  the  dedication  of  the  first 
Labor  Clinic. 

1  November,  1910. 


158  MODERN  ITALIAN  SURGERY 

"  For  the  Scientific  Study  of  Prevention  of  Occupational  Diseases" 
is  the  inscription  in  letters  of  gold  on  a  background  of  white  marble 
over  the  entrance  of  this  unique  hospital. 

Three  large  four-story  buildings,  new  and  well  equipped  with 
the  latest  scientific  apparatus  in  laboratories,  hospital  wards, 
lecture  rooms  and  library,  are  here  frankly  dedicated  to  the 
elimination  of  those  diseases  peculiar  to  industrial  employments. 

Already  twelve  scientific  men  are  cooperating  with  the  director, 
Dr.  Devoto,  although  the  laboratories  were  not  opened  until 
March  20. 

In  one  of  the  hospital's  wards  the  director  is  giving  special 
attention  to  fourteen  patients.  One  of  these,  a  man  trembling 
with  the  peculiar  palsy  due  to  mercurial  poisoning,  began  work  in 
a  hat  factory  when  ten  years  of  age  and  felt  the  effect  of  the 
poison  almost  immediately. 

Another  patient  suffers  with  lead  colic,  the  result  of  his  work  as  a 
house  painter.  Seven  of  his  thirteen  children  died  during  the  first 
few  months  after  they  came  into  the  world,  on  account,  perhaps, 
of  the  presence  of  poison  in  the  father's  system. 

Other  patients  are  being  treated  for  ills  occasioned  by  work 
in  high  temperatures,  in  dusty  or  poisonous  atmospheres  and  from 
the  results  of  overstrain. 

The  laboratories  too  are  fully  equipped. 

Here  we  find  treadmills  in  which  dogs  patiently  trot  up  endless 
hills  in  order  that  their  blood  corpuscles  may  disclose  new  truths 
concerning  the  toxin  of  fatigue.  Machines  register  on  revolving 
disks  the  fluctuating  curves  inscribed  by  long  series  of  muscular 
strains,  in  order  that  the  effects  of  overwork  and  artificial  stimulus 
may  be  correlated  with  immunity  from  disease. 

Here,  too,  "leaded"  mother  goats  and  guinea-pigs  add  to  our 
fund  of  knowledge  concerning  the  effect  of  lead  poisoning  upon 
premature  birth  and  the  supply  of  mother's  milk. 

These  experiments,  moreover,  are  of  much  more  than  ordinary 
laboratory  interest. 

A  practical  provision  extends  the  activities  of  the  clinic  into 
industrial  establishments,  and  supplements  the  work  of  Govern- 
ment factory  inspectors. 


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INSTITUTES  OF  LEARNING  IN  MILAN  159 

Dr.  Carozzi,  who  has  devoted  much  time  to  this  important 
work,  is  fully  supplied  with  portable  air-test  devices.  When  called 
upon  by  the  department,  he  is  authorized  to  enter  the  establish- 
ment to  inspect  sanitary  conditions. 

These  practical  experiments  carried  on  with  a  broad  scientific 
devotion  to  the  conservation  of  human  resources,  offer  both 
encouragement  and  reproach  to  us  in  the  United  States. 

What  have  we  of  equal  value  to  offer  the  sons  and  daughters  of 
Italy,  whom  we  invite  to  our  shores?  Country  dentists  have  con- 
fessed to  us  that  they  were  merely  "experimenting"  with  match- 
factory  employees  afflicted  with  the  dreadful  phossy  jaw. 

Industrial  diseases  of  many  kinds  are  leaving  pitiful  wrecks  to 
burden  and  shame  us. 

Is  it  not  a  matter  of  reproach  that  it  was  not  in  weary  smoke- 
begrimed  Pittsburgh,  nor  amid  the  textile  mills  of  New  England, 
nor  among  the  mines  and  smelters  and  factories  of  the  great  in- 
dustrial centers  of  the  United  States,  but  beneath  the  sunny 
skies  of  Italy  that  this  need  found  tangible  expression  in  the 
first  clinic  for  industrial  diseases? 

When  Florence  Nightingale  and  Henri  Dunant  saw  the  battle- 
field strewn  with  dead  and  wounded,  they  gave  a  moment  of 
thought  and  then  passed  on  to  the  world  an  idea  which  grew  into 
that  beneficent  organization  known  as  the  Red  Cross. 

Since  that  time  wherever  men  might  be  injured  in  the  activity 
of  war  the  means  for  quick  relief  have  been  supplied. 

During  the  same  half  century,  however,  the  industrial  field  with 
its  activities  of  peace  has  extended  and  grown  more  mechanical, 
until  it  maims  now  more  men  than  war  ever  did. 

In  the  United  States  we  are  just  beginning  to  realize  that  30,000 
wage  earners  are  killed  by  industrial  accidents  every  year,  and 
that  at  least  500,000  more  are  seriously  injured. 

And  now,  carefully  prepared  by  a  committee  of  experts,  appoint- 
ed by  the  President  of  the  Association  of  Labor  Legislation  and 
thoughtfully  received  by  the  President  of  the  United  States, 
comes  a  memorial  on  industrial  diseases,  which  discloses  industrial 
injuries  of  still  greater  magnitude. 
In  this  admirable  memorial  of  facts  and  figures,  we  learn  that 


i6o 


MODERN  ITALIAN  SURGERY 


in  the  United  States  there  are  probably  no  less  than  13,000,000 
cases  of  sickness  each  year  among  those  engaged  in  industrial 
employments.  The  money  loss  each  year  (for  those  who  find 
dollars  more  impressive  than  lives)  is  calculated  by  these  con- 
servative experts  at  nearly  three-quarters  of  a  billion  dollars. 
At  least  one-fourth  of  this  painful  incapacity  for  work  and  conse- 
quent economic  loss,  we  are  told,  can  be  prevented  .    .    . 

The  appreciation  of  the  Secretary  of  the  American 
Association  of  Labor  Legislation  was  a  fine  and  just 
compliment  to  the  original  enterprise  of  the  Labor 
Party  of  Milan.  But  the  activity  and  energy  of  the 
people  of  Milan  have  not  been  confined  to  a  party,  for, 
under  the  indefatigable  leadership  of  the  eminent 
Prof.  Luigi  Mangiagalli,  endowments  and  appropriations 
were  solicited  and  obtained,  so  that  the  administration 
of  the  Istituti  Scientifici  was  able  to  enlarge  its  sphere 
of  work,  and  select  an  efficient  staff  for  the  various 
clinics  as  follows: 


Divisions 

Obstetrics-Gynecology 
Industrial  Diseases 
Clinical  Anatomy 
Orthopedic  Clinic 
Epidemic,  Contagious  Diseases 

Traumatology 

Social  Medicine 
Physiopathology   and   Experi- 
mental Therapy  in  Infections 
Public  andlndustrial  Hygienics 

Special  Dental  Pathology 
Dental  and  Periodontal  Surgery 
Dental  Prosthesis 
Conservative  Odontotherapy 


Special  Institutes  or 
Clinics 

Institute  and  Hospital 

Labor  Clinic 

Main  Hospital 

Institute  for  Cripples 

Hospital  for  Contag- 
ious Diseases 

Ponti's    Ward    Main 
Hospital 

Main  Hospital 

Institute     of    Serum 
Therapy 

Special  Clinic 
Institute 

Stomatologic  Institute 

Stomatologic  Institute 

Stomatologic  Institute 

Stomatologic  Institute 


Professors 

Luigi  Mangiagalli 
Luigi  Devoto 
Ferdinando  Livini 
Riccardo  Galeazzi 
Giovanni  Polverini 

Baldo  Rossi 

Edoardo  Bonardi 
Serafino  Belfanti 

Ernesto  Bertarelli 

Gaetano  Fasoli 
Camillo  Rovida 
Carlo  Platschick 
Lodovico  Couillauz 


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INSTITUTES  OF  LEARNING  IN  MILAN  161 

To  the  regular  official  course  of  lessons  must  be 
added  free  lecture  courses  as  follows:  Medical  History 
(Prof.  Piero  Giacosa);  Neuropathology  (Prof.  Eugenio 
Media);  Gastrointestinal  Surgery  (Professor  Clavini); 
Dermosyphilography  (Professor  Pasini) ;  Urology  (Pro- 
fessors Lasio  and  Sigurta);  Criminal  Anthropology 
(Professor  Del  Greco) ;  Pathologic  Anatomy  (Professor 
Zenoni). 

Milan  has  at  present  a  splendid  post-graduate  school 
system,  and  there,  in  the  great  metropolis  of  commerce, 
industry  and  activity  in  every  branch  of  enterprise, 
a  doctor  finds  ample  field  for  perfecting  the  knowledge 
he  has  acquired  in  a  university,  turning  it  into  practical 
application. 

Milan  claims  among  its  distinguished  surgeons 
several  men  celebrated  in  the  profession  for  their 
contributions  to  surgical  literature.  All  distinguished 
themselves  for  efficient  services  during  the  Great  War. 
Among  them  were  Prof.  Baldo  Rossi,  director  of  the  so- 
called  "movable  hospital"  at  the  front;  Prof.  Andrea 
Majocchi,  known  in  America  for  his  enthusiastic 
publications  on  American  surgery;  and  Prof.  Riccardo 
Galeazzi,  already  mentioned,  whose  numerous  publi- 
cations are  a  credit  to  his  very  enterprising  activity. 

The  growth  of  Milan  in  the  last  twenty  years  has  been 

marvellous.  Its  topographic  position  in  the  center  of  the 

most  fertile  province  of  northern  Italy,  its  geographic 

location,  which  made  it  the  emporium  for  the  trade 

between  the  Mediterranean,   with  its  port  of  Genoa 

in  the  south,  and  Switzerland,  Bavaria,  Austria  and 

the  northern  states,  gave  it  an  impetus  of  prosperity 

worthy  of  the  energy  of  its  citizens.  The  Milanese  are 
11 


162  MODERN  ITALIAN  SURGERY 

trying  to  make  it  also  a  center  of  intellectual  advance- 
ment, as  it  is  already  of  industrial  and  commercial 
progress.  Two  mountain  railroads  further  its  commercial 
communications — the  St.  Gotthard,  and  the  Jura-Simp- 
Ion  Railways. 

Milan  is  only  a  few  miles  from  the  great  Italian 
lakes  and  is  near  all  the  best  mountain  resorts  of  the 
Alps.  It  thus  became  the  natural  headquarters  for  many 
interesting  excursions.  As  a  result,  there  was  founded  a 
most  active  organization,  "The  Touring  Club  of  Italy," 
one  of  the  best  frequented  and  patronized  institutions 
of  the  country. 

Less  than  fifty  miles  north,  near  the  pretty  city  of 
Bergamo,  there  is  a  famous  health  resort  (for  stomach  and 
intestinal  diseases),  which  combines  both  the  climatic 
and  medicinal  properties  of  the  spring,  producing  most 
wonderful  cures.  San  Pelligrino  is  a  well-known  resort, 
well  equipped  with  commendable  establishments  and 
comfortable  hotels  and  surrounded  by  beautiful  country. 


Chapter  XVII 
THE  UNIVERSITY  OF  TURIN 

NO  Italian  would  or  could  deny  that  Turin 
has  been  the  cradle  of  the  unity  of  Italy, 
that  the  little  kingdom  of  Piedmont  was  the 
first  to  have  a  liberal  constitution,  which  the 
people  demanded  in  1847,  and  which  Carlo  Alberto  of 
the  house  of  Savoy  conceded  in  1 848,  when  at  the  head 
of  a  small  army  he  dared  to  challenge  the  most  powerful 
army  of  the  most  powerful  empire  of  that  time — 
Austria-Hungary.  History  has  recorded  that  fatal 
campaign  of  1849,  when  another  army  of  Piedmont, 
reinforced  by  the  lovers  of  liberty  of  all  Italy,  attacked 
the  big  army  of  Austria,  and  was  defeated  at  Novara. 
But  the  people  did  not  renounce  the  aspiration  of  a  free 
Italy.  In  1859  a  fortunate  campaign  gave  Lombardy 
to  Italy,  and  in  i860  the  kingdoms  of  Naples  and  Sicily 
became  free,  thanks  to  the  courage  and  audacity  of 
Garibaldi,  the  idol  of  Italian  independence. 

From  Turin,  the  great  Cavour,  seconded  by  Victor 
Emanuel  11,  the  chivalrous  king,  cleverly  directed  the 
difficult  political  muddle  of  that  time  and  prepared  that 
unification  of  Italy  which  was  the  poetical  dream  of 
Dante,  and  later,  the  practical  dream  of  Mazzini. 
For  many  years,  Turin  was  the  center  of  political 
conspiracies  of  patriots  gathered  from  all  over  Italy, 
exiled  by  the  Austrians,  Neapolitans,  Tuscans,  and  by 
the  small  princely  rulers  who  feared  the  loss  of  their 
thrones. 

163 


164  MODERN  ITALIAN  SURGERY 

In  the  turmoil  of  political  agitations  and  during  the 
period  of  transition  from  the  antiquated  system  of 
education  to  the  modern  liberal  ideas,  study  at  the 
university  was  somewhat  neglected,  not  for  lack  of 
superior  men  as  teachers,  but  on  account  of  the  general 
restless  condition  of  the  minds  of  the  younger  genera- 
tion, almost  continually  excited  by  patriotic  events. 

Turin,  the  capital  of  Piedmont,  is  a  delightful  city 
of  about  500,000  inhabitants,  built  along  the  left 
border  of  the  River  Po,  which  runs  at  the  foot  of  a 
chain  of  most  picturesque  hills,  The  elevation  is  covered 
with  numerous  and  elegant  villas,  as  far  down  as  the 
famous  Basilica  of  Superga  where  are  the  tombs  of  the 
kings  and  princes  of  the  house  of  Savoy.  Opposite  the 
chain  of  hills,  which  is  in  the  south  of  the  city,  far  away 
to  the  north,  appears,  in  the  form  of  an  amphitheater, 
the  chain  of  the  majestic  Alps,  some  covered  by 
perpetual  snow.  Although  of  very  ancient  origin, 
rebuilt  with  modern  design  and  taste,  Turin  has  beauti- 
ful wide  streets,  with  elegant  parks,  one  of  which,  the 
Valentino,  has  an  historical  castle  built  on  the  edge  of 
the  river,  surrounded  by  luxurious  gardens.  Many 
squares  artistically  laid  out  are  adorned  with  fine 
monuments  in  bronze  and  marble,  and  long  boulevards 
planted  with  beautiful  trees  are  the  pride  of  the  city. 

Turin,  during  the  early  period  of  the  formation  of 
Italian  unity,  in  the  middle  of  the  last  century,  was 
the  intellectual  and  political  center  of  the  country. 
But  after  the  removal  of  the  capital  to  Rome,  Turin 
lost  its  political  importance  and  became  the  active 
center  of  industrial  enterprises,  excelling  in  cotton-goods 
factories,   in  mechanical  products,   and   especially  in 


THE  UNIVERSITY  OF  TURIN  165 

automobile  manufactures — for  instance,  the  well-known 
"  Fiat,"  one  of  the  best  machines  of  its  kind  in  the  world. 
The  university,  which  is  considered  one  of  the  best  in 
Italy,  was  founded  in  1404  by  Pope  Benedict  xm. 
After  many  vicissitudes  due  to  long  periods  of  war,  it 
reached  its  most  splendid  epoch  under  Victor  Ame- 
deus  11  and  later  under  Carlo  Emanuel  in  of  Savoy, 
king  of  Sardinia  (1771)-  Under  the  French  Republic, 
and  the  Napoleonic  Empire,  it  was  well  endowed,  and 
gained  an  important  place  after  the  unification  of  Italy. 
King  Carlo  Alberto,  toward  the  middle  of  the  last 
century,  founded  a  college  which  bears  his  name.  He 
established  one  hundred  gratuitous  tuitions.  Thirty-five 
were  afterward  added,  by  private  contributions,  for 
worthy  students  without  means. 

The  University  of  Turin  possesses  also  a  Royal 
Academy  of  Medicine  founded  in  1838.  This  has  a  large 
library  of  120,000  volumes,  with  50,000  pamphlets, 
and  1 20  monthly  and  weekly  reviews,  publishing  besides 
the  Journal  0/  the  Academy  0/  Medicine,  which  has 
reached  its  one  hundred  and  fiftieth  number. 

The  school  of  medicine  of  the  University  of  Turin  has 
been  renowned  throughout  the  world  for  its  two 
anatomists  whose  discoveries  are  recorded  with  their 
name :  Luigi  Rolando,  who  described  the  area,  convolu- 
tion and  fissure  of  the  brain;  and  Carlo  Giacomini,  who 
described  the  grayish  band  of  the  fascia  dentata  of  the 
hippocampus.  Both  these  anatomists,  during  their 
period  of  teaching  in  the  last  century,  left  numerous 
publications  of  great  value,  holding  aloft  the  reputation 
of  a  school  of  anatomy  which  has  been  and  is  yet  con- 
sidered one  of  the  best  in  Italy. 


166  MODERN  ITALIAN  SURGERY 

In  the  last  score  of  years  several  buildings  have  been 
constructed  for  the  scientific  institutes  of  physiology, 
normal  anatomy,  pathology  (anatomic  and  surgical), 
and  others  intended  for  the  various  branches  of  medicine 
and  surgery.  Those  already  connected  with  many  of  the 
hospitals  have  been  properly  improved  and  equipped 
with  modern  appliances  so  as  to  fit  them  for  modern 
research. 

The  institute  of  surgical  pathology  was  directed, 
until  last  year,  by  Prof.  Daniele  Baiardi,  who,  on 
account  of  the  age  limit,  was  compelled  to  retire, 
much  to  the  regret  of  the  faculty  and  his  faithful  pupils. 
Unfortunately  very  little  is  known  of  the  numerous 
publications  of  Prof.  Daniele  Baiardi,  for  few  have  been 
translated  from  the  Italian.  His  original  and  interesting 
studies  on  bones,  and  his  experiments  on  the  formation 
of  callus  in  cases  of  fracture  of  long  bones  (1879),  are 
most  valuable  and  complete.  These  were  followed  by 
some  other  experimental  studies  on  neo-formation  of 
bony  substance  in  the  medullary  canal  and  in  the 
epiphysis,  and  on  the  regeneration  of  the  medulla  of  the 
long  bones.  Many  other  works  of  as  great  importance 
were  the  result  of  his  experimental  studies;  as  for 
example,  his  contribution  on  the  formation  of  neoar- 
throsis in  traumatic  luxations,  and  on  the  regeneration 
of  the  articular  joints  in  subcapsuloperiosteal  resection 
(1882).  Other  publications  to  his  credit  are  on  vaginal 
primary  sarcoma,  varicose  veins  of  the  right  arm, 
infantile  congenital  stricture  of  the  jaws,  and  primitive 
muscular  angioma  (1901) — all  of  which  gave  him  the 
well-deserved  reputation  of  a  conscientious  student 
and  learned  pathologist. 


THE  UNIVERSITY  OF  TURIN  167 

The  surgical  clinic  is  under  the  direction  of  one  of  the 
most  clever  surgeons  and  learned  teachers  of  surgery  of 
which  Italy  can  boast — Prof.  Antonio  Carle,  who 
recently  (191 2)  built  at  his  own  expense,  the  surgical 
institute  for  diseases  of  the  stomach  and  the  intes- 
tines, attached  to  the  Hospital  Umberto  1,  of  which 
he  has  been  the  clinical  director  for  a  great  many 
years. 

L'Ospedale  Mauriziano  Umberto  Primo,  as  it  is 
called,  is  a  model  of  modern  hospitals  and  a  credit  to 
the  city  of  Turin,  but  especially  to  Professor  Carle,  who 
with  indefatigable  activity  has  kept  it  to  the  highest 
up-to-date  standard.  Professor  Carle  was  the  first, 
in  conjunction  with  Dr.  Rattone,  to  discover  the 
Bacillus  clavatus — the  tetanus  germ  (afterward  de- 
scribed by  Nicolaier),  and  to  demonstrate  the  possible 
transmission  of  the  dreaded  disease. 

In  a  work  published  in  collaboration  with  Professor 
Fantino,  his  assistant  (in  1898),  Professor  Carle  illus- 
trates by  means  of  important  and  remarkable  statistics 
the  success  in  gastric  surgery,  especially  in  the  early 
period  of  stomach  operations.  In  1899  he  published 
"A  Contribution  to  the  Surgery  of  the  Thyroid"  with 
extensive  statistics  on  the  operation  for  goiter,  and 
shortly  after,  "A  Contribution  on  the  Operative 
Treatment  of  Fibromyoma  of  the  Uterus  With  979 
Cases."  He  also  contributed  notably  to  our  knowledge 
of  surgery  of  the  kidneys  and  biliary  organs. 

One  of  the  greatest  merits  of  Professor  Carle,  beside 
his  recognized  scientific  achievements  and  his  known 
ability  as  a  successful  surgeon,  is  his  excellence  as  a 
teacher.  Many  of  his  pupils  occupy  some  of  the  most 


168  MODERN  ITALIAN  SURGERY 

coveted  positions  as  professors  of  surgical  clinics  and 
directors  of  hospitals,  which  must  be  a  great  satisfaction 
to  a  man  who  has  devoted  all  his  life  to  scientific  studies 
and  the  practical  application  of  his  learning  to  the 
advancement  of  surgery. 

The  city  of  Turin  has  several  important  hospitals, 
operated  especially  as  charitable  institutions,  with  a 
few  rooms  for  the  accommodation  of  private  patients 
who  can  pay  for  attendance  and  treatment.  Some  of  these 
hospitals  are  built  according  to  the  latest  requirements 
of  science.  Others  have  been  remodelled;  all  of  them 
have  modern  operating  rooms,  and  most  of  them  are 
equipped  with  the  latest  x-ray  apparatus,  indispensable 
to  modern  medicine  and  surgery. 

The  San  Giovanni  Hospital  deserves  special  mention. 
This  is  the  largest  and  oldest  hospital  in  the  city,  but 
has  been  remodelled  to  suit  present-day  progress.  Two 
prominent  surgeons  direct  the  principal  sections  of  the 
San  Giovanni — Prof.  Luigi  Bobbio,  who  distinguished 
himself  during  the  Great  War  as  a  major  in  the  Medical 
Corps,  and  Prof.  Valentino  Oliva.  Professor  Bobbio, 
who  is  a  free  docent  and  assistant  to  Professor  Baiardi, 
is  the  author  of  an  elaborate  contribution  to  surgical 
literature,  in  sixty  pamphlets,  on  almost  every  subject 
of  surgery.  In  one  of  the  pamphlets  he  summarizes  the 
clinical  work  of  ten  years.  It  is  almost  impossible  to  give 
a  fair  criticism  of  such  an  extensive  work,  but  certainly 
some  of  his  contributions  are  highly  commendable  for 
their  originality  and  the  clear  exposition  of  the  cases. 

Able  assistants  to  Profs.  Antonio  Carle  and  Daniele 
Baiardi,  distinguished  for  their  work  and  publications, 
are  the  free-docent  Profs.  Lodovico  Isnardi;  Giovanni 


THE  UNIVERSITY  OF  TURIN  169 

Battista  Boccasso;  Giuseppe  Serafmi;  Candfdo  Man- 
telli;  Ottorino  Ufferduzzi;  Andrea  Marro;  Lorenzo  de 
Bernardi;  and  Ugo  Camera. 

Several  summer  resorts  in  the  mountains  can  be 
reached  from  Turin,  a  few  of  them  with  springs  of  well- 
known  reputation  for  stomach  and  skin  diseases,  like 
St.  Vincent  and  Courmayeur  in  the  valley  of  Aosta.  One 
of  the  most  famous  springs  since  the  time  of  the  ancient 
Romans  is  the  boiling  sulphurous  water  of  Acqui.  Near 
each  of  these  springs  and  resorts  there  are  several 
comfortable  hotels;  the  Acqui  spring  is  situated  in  a 
very  interesting  agricultural  city,  three  hours  by  rail 
from  Turin.  Acqui  has  two  large  and  well-equipped 
establishments  for  sulphur  and  mud  baths,  renowned 
for  their  efficacy  in  rheumatic  affections,  especially  of 
the  joints. 

Not  far  from  Turin,  there  are  two  well-known 
and  well-patronized  establishments  for  medicated  baths, 
well  equipped  with  modern  conveniences  and  com- 
fortable hotels.  Both  establishments  are  on  the  railroad 
line,  Torino  Cuneo,  whence  they  can  be  reached  by 
tram  cars  and  buses.  Both  are  renowned  for  the  so-called 
"hot  mud,"  applied  over  rheumatic  articulations  with 
wonderful  effect.  The  country  around  is  also  very 
attractive  for  mountain  excursions  and  for  sport. 


Chapter  XXIII 
THE  UNIVERSITY  OF  GENOA 

GENOA  is  called  "La  Superba,"  according  to 
some  historians,  on  account  of  its  superb 
position,  but  perhaps,  also,  on  account  of  the 
very  proud  disposition  of  the  inhabitants,  who 
are  very  exclusive  and  rather  aristocratic  in  social 
intercourse,  although  very  liberal  and  democratic  in 
ideas.  But  whatever  may  be  the  right  reason,  the 
epithet  fits  well,  for  there  are  few  cities  in  the  world 
built  with  such  superb  palaces,  standing  artistically 
disposed  along  the  side  of  the  high  hills  which  surround 
the  marvellous  gulf  that  nature  seems  to  have  made  for 
a  safe  landing  and  shelter  of  ships.  History  has  written 
in  golden  letters  the  names  of  Cristoforo  Colombo, 
Andrea  Doria  and  Giuseppe  Mazzini,  among  many 
other  celebrated  men  in  the  navy  and  army,  in  politics, 
literature,  art  and  trade,  which  made  Genoa  famous  in 
the  far  and  near  past. 

The  date  of  foundation  is  rather  obscure.  For  a  long 
time  it  was  thought  to  have  been  originally  a  Roman 
colony.  However,  in  recent  excavations  for  the  con- 
struction of  the  new  Via  Venti  Settembre  more  than 
eighty  tombs  of  Greek  origin,  dating  from  the  fourth  or 
fifth  century  B.C.,  were  found,  which  prove  that  Genoa 
had  been  colonized  before  the  Romans,  who  came  only  in 
the  second  century  B.C.,  and  restored  it  after  its  destruc- 
tion by  the  Carthaginians. 

Genoa  followed  the  rest  of  Italy  in  its  vicissitudes 

170 


THE  UNIVERSITY  OF  GENOA  171 

under  French  and  German  invasions  and  jealousy.  It 
was  divided  into  Guelph  and  Ghibelline  factions,  and 
suffered  internally  by  continual  disputes  between  the 
nobles  and  the  commoners. 

The  common  danger  of  the  Saracens  made  Genoa 
strong  as  a  naval  power,  and  from  that  she  extended  her 
colonies  in  the  Orient,  along  the  Spanish  coast  and  the 
coast  of  Barbary,  enlarging  her  possessions  on  the 
Black  Sea  and  along  the  Euphrates. 

One  of  the  most  remarkable  features  of  commercial 
Genoa  is  the  famous  "  Banco  di  San  Giorgio, "  an  institu- 
tion founded  in  the  fourteenth  century,  which  financed 
all  the  big  Genoese  enterprises  during  the  zenith  of 
Genoa  as  a  republic,  and  terminated  with  the  conquest 
by  Napoleon  in  1 796.  The  palace  remains  as  a  national 
monument  of  one  of  the  most  flourishing  banking 
institutions  of  the  Middle  Ages  and  of  the  commercial 
power  of  Genoa. 

Modern  Genoa  is  a  beautiful  city  of  about  300,000 
inhabitants,  considered  the  most  active  and  most 
enterprising  in  the  whole  country.  Its  splendid  port 
has  been  greatly  enlarged  by  the  Government  and  with 
the  generous  contribution  of  several  millions  from 
Duke  de  Ferrari  Galliera,  who  also  left  a  large  estate 
for  a  hospital  which  goes  under  the  family  name. 
Other  great  improvements  have  been  and  are  con- 
tinually being  added  to  this  magnificent  port  which  is 
the  most  important  on  the  Mediterranean  Sea,  com- 
manding the  principal  trade  with  North  and  South 
America  and  the  whole  oriental  coast.  Annexed  to 
the  port  is  a  large  and  famous  shipyard,  named 
"Ansaldo,"  after  the  founder.  Here  many  large  ships 


172  MODERN  ITALIAN  SURGERY 

are  launched  for  commercial  purposes,  and  50,000  men 
find  continual  and  active  occupation. 

The  University  of  Genoa  is  perhaps  the  youngest 
of  the  Italian  universities,  as  only  in  1773  were  the 
special  subjects,  previously  taught  separately,  combined 
in  one  organization. 

When  Napoleon,  to  ingratiate  himself  with  the 
inhabitants  of  Genoa,  established  a  regular  university 
in  18 1 2,  the  school  of  anatomy  was  the  first  to  rise  to 
particular  reputation.  The  father  of  Giuseppe  Mazzini, 
the  great  Italian  patriot,  held  the  chair  of  anatomy  from 
1816  to  1844,  inaugurating  the  Anatomical  Museum, 
where  today  some  interesting  preparations  left  by 
Prof.  Giacomo  Mazzini  and  his  assistant,  Giuseppe 
Locatelli,  may  be  admired. 

As  successor  to  Giacomo  Mazzini  in  1844,  came  Prof. 
Cristoforo  Tomati,  who  gave  to  the  school  a  new 
scientific  basis  and  impulse,  in  consonance  with  the  pro- 
gressive times.  He  started  his  lectures  with  the  com- 
parative embryological  and  histological  method,  well 
assisted  by  his  worthy  pupils,  Luigi  Ageno,  Torquato 
Beisso,  Minaglia  and  Sivori,  beside  a  private  anatomist, 
Giuseppe  de  Negri,  who  left  some  original  publications 
on  the  anatomy  of  the  inguinal  and  crural  regions  in 
reference  to  the  hernia  of  those  parts. 

In  1859  Professor  Tomati  was  called  to  the  University 
of  Turin.  He  was  succeeded  by  Luigi  Ageno,  who 
published  several  very  important  studies : 

1.  De  FoIIiculis  Interstitialibus  et  Gangliis  Mesentericis, 
et  Speciatim  De  Eorum  in  Febre  Tiphoide  Lesionibus. 

2.  Anatomic  Science  Considered  in  the  Principal  Epochs  of 
Its  History. 


THE  UNIVERSITY  OF  GENOA  173 

3.  The  Combined  Anatomicophysiologic  Studies  and  Medical 
Science. 

Many  other  publications  from  Prof.  Luigi  Ageno 
remain  as  contributions  during  his  thirty  years  of  tuition, 
after  which  his  successor,  Torquato  Beisso,  in  his  short 
period  of  professorship,  left  some  important  studies  on 
the  medulla  and  the  encephalon. 

After  Professor  Beisso,  Pier  Michele  Guerica  held  the 
chairs  of  both  descriptive  and  topographic  anatomy, 
publishing  a  great  many  important  works,  especially  on 
the  nervous  system  of  the  hand,  and  on  the  muscles  of 
mastication.  At  present  the  professor  of  both  descrip- 
tive and  topographic  anatomy  is  Pilade  Lachi,  assisted 
by  Carlo  Ganfini,  special  lecturer  on  embryology. 

In  1885  the  University  was  organized  on  the  lines  of 
the  other  Italian  universities,  with  complete  courses 
of  study,  and  with  special  buildings  and  laboratories. 

The  school  of  surgery  of  the  University  of  Genoa, 
during  the  last  half  century,  has  been  graced  by  two 
very  prominent  surgeons  and  teachers,  Azzio  Caselli 
and  Giacomo  Filippo  Novaro.  Of  Azzio  Caselli's  long 
period  of  teaching  there  remains  an  extensive  contri- 
bution to  surgery  on  almost  every  subject,  from  brain 
surgery,  amputation  of  the  tongue,  experimental  studies 
and  their  application  in  stomach  and  intestinal  surgery, 
resections  of  the  knee  and  elbow,  to  practical  surgery 
of  the  larynx  and  thyroid  gland. 

Giacomo  Filippo  Novaro,  who  followed  Professor 
Caselli  in  1898,  was,  for  several  years,  previously,  head 
of  the  surgical  clinic  of  Bologna,  where  he  had  succeeded 
Pietro  Loreta,  the  eminent  surgeon  who  died  in  1895. 
It  would  be  difficult  to  review,  even  in  part,  the  great 


174  MODERN  ITALIAN  SURGERY 

and  valuable  work  of  Professor  Novaro  during  his  long 
period  of  teaching  at  the  University  of  Turin,  at  that  of 
Siena  and  afterwards  at  Bologna  and  Genoa,  whence,  on 
account  of  the  age  limit,  he  was  retired  only  last  year. 

Well  known  are  Novaro's  experimental  works  on  the 
resection  of  the  intestine  (early  in  the  1870).  He  was  the 
first  in  Italy  to  resect  the  esophagus  for  cancer  by 
esophagoplasty  (1872),  the  second  case  after  that  of 
Czerny.  His  modifications  in  laryngectomy,  gastro- 
enterostomy, cholecystectomy,  typhlostomy,  the  radical 
cure  of  crural  hernia  by  a  special  method,  with  a  flap 
of  the  pectineus,  and  many  other  original  studies,  which 
mark  a  real  progress  in  scientific  and  practical  surgery, 
are  well  known. 

Although  a  great  scientist,  in  his  lectures  Novaro 
always  tried  to  explain  the  practical  side  of  surgery  for 
the  benefit  of  the  majority  of  the  pupils,  whose  careers 
were  to  be  along  the  lines  of  practical  work.  For  the 
same  reason  he  insisted  on  special  care  in  accurate 
diagnosis.  During  the  Great  War,  he  was  honored  with 
a  generalship,  his  special  work  being  that  of  an  efficient 
organizer,  well  appreciated  in  the  urgent  need  for  prac- 
tical men. 

There  are  few  topics  of  clinical  and  operative  sur- 
gery that  Novaro  has  not  studied,  discussed  and 
often  modified  with  original  and  modern  views.  He 
was  one  of  the  first  in  Italy  who  contributed  to  the 
surgery  of  the  neck,  thorax  and  abdomen.  In  laryn- 
gectomy he  was,  for  that  early  time,  daring  and  technic- 
ally perfect.  He  devoted  much  time  to  the  study  of 
diseases  of  the  intestinal  tract,  and  early  performed 
pyloric     divulsion,     pylorplasty     and     gastro-entero- 


Prof.  G.  F.  Novaro,  Genoa. 


THE  UNIVERSITY  OF  GENOA  175 

anastomosis.  In  1890  he  published  "A  Contribution  to 
Gastric  Surgery"  in  which  he  reports  the  details  of  his 
operations. 

Novaro  also  published  cases  of  nephrectomy,  extirpa- 
tion of  the  gasserian  ganglion  for  neuralgia,  resection 
of  the  intestine,  operations  on  the  pancreas,  and  on  the 
spleen.  He  proposed  typhlostomy  for  the  treatment 
of  ulcerative  colitis  (1887);  introduced  into  Italy  car- 
pectomy  with  the  dorsodigital  method  of  Studegard; 
and  published  a  very  important  work  on  transfixing 
the  uterus  to  the  bladder  through  the  peritoneum,  or 
grafting  both  to  the  large  intestine,  and  on  the  extirpa- 
tion of  the  bladder  and  the  prostatic  gland  (1887). 

The  work  of  Professor  Novaro  has  ever  been  inspired 
by  the  highest  spirit  of  modernism  and  progress,  and 
he  deserves  credit  in  having  transmitted  such  noble 
ambition  to  all  his  numerous  pupils. 

Independent  of  the  clinic  of  the  university,  is  the 
"Institute  of  Operative  Medicine"  directed  by  Prof. 
Attilio  Catterina,  who,  besides  many  cases  on  the  ana- 
tomical pathology  of  tumors,  has  to  his  credit  some 
important  cases  of  clinical  operations.  He  popularized 
the  method  of  carpectomy  with  a  longitudinal  method 
which  goes  by  his  name,  together  with  many  other 
original  methods  in  the  surgery  of  articulations. 

One  of  the  most  distinguished  pupils  of  Novaro 
was  Prof.  Ernesto  Bozzi,  teacher  of  special  surgical 
pathology,  a  promising  pathologist  who  for  fifteen  years 
directed  the  Institute  at  the  University  of  Genoa  and 
who  fell  a  victim  in  the  recent  war,  while  serving  as 
major  at  the  front,  in  consequence  of  an  enteritis 
followed    by   acute   pneumonia.    Professor    Bozzi   left 


i76  MODERN  ITALIAN  SURGERY 

some  capital  contributions  on  the  pathology  of  the 
thyroid,  the  rehabilitation  of  the  functions  of  the 
hydronephrotic  kidney,  cholecystenterostomy,  fungoid 
mycosis,  and  many  other  important  studies.  Not  long 
before  his  death,  in  a  splendid  conference  at  the  Con- 
gress of  Bologna,  and  later,  in  Geneva,  he  exhibited  his 
notable  successes  in  abdominal  surgery  during  the  war, 
advising  a  prudent  and  early  intervention. 

Bozzi's  name  must  not  be  confused  with  that  of  Luigi 
Maria  Bossi,  professor  of  gynecology,  who  had  a  period 
of  fame  because  of  his  instrument  for  quick,  forcible 
uterine  dilatation,  and  who  also  died  a  few  years  ago. 

The  surgical  faculty  of  the  Institute  of  Operative 
Medicine  had  on  its  staff,  Prof.  Erasmo  de  Paoli,  who 
previously  was  professor  of  clinical  surgery  at  the 
University  of  Perugia,  leaving  there  a  record  of  good  and 
efficient  teaching  and  several  publications  on  arthrec- 
tomy  of  the  knee,  nephropexy,  resection  of  the  kidney, 
strumectomy  and  other  original  work. 

Genoa  is  favorably  situated  on  the  shores  of  a  large 
gulf  with  the  famous  Riviera,  "di  Levante"  (or  Western 
Riviera)  and  "di  Ponente"  (or  Eastern  Riviera). 
Travellers  are  familiar  with  both  these  winter  resorts  all 
along  the  coast,  for  hundreds  of  miles  famous  for  the 
balmy  weather  on  both  sides,  and  for  beautiful  towns 
with  splendid  hotels,  well  known  the  world  over. 

Well  known  the  world  over  are  also  the  names  of 
Nervi,  only  a  few  miles  east  of  Genoa,  Santa  Margherita, 
Portofino,  Rapallo,  Chiavari,  Spezia,  so  dear  to  the 
tourist,  as  well  as  the  west  coast,  beginning  from  the 
renowned  and  pretty  town  of  Pegli,  following  along 
to  Arenzano,  Savona,  Albenga,  Alassio,  Diano-Marina, 


THE  UNIVERSITY  OF  GENOA  177 

San  Remo  and  Bordighera,  near  Monaco  and  Nice. 
These  are  all  famous  resorts,  where  sea  bathing  is  well 
patronized  for  half  of  the  year  and  where  the  balmy 
weather,  so  beneficial  to  lung  troubles  and  weak  consti- 
tutions, is  recommended  for  the  winter  season. 

In  the  middle  of  the  last  century  a  philanthropic 
physician  started  what  in  Italy  are  called  the  "Ospizii 
Marini"  for  children,  with  the  scope  of  sending  to  the 
seaside  those  poor,  delicate  beings  who  could  not  afford 
the  benefit  of  the  sea  air  and  salt  water  cure  so  efficient 
in  many  diseases.  The  Ospizii  Marini  are  today  a 
flourishing  institution  supported  by  private  subscrip- 
tions, and  patronized  by  a  great  many  ladies  of  the 
best  social  standing,  who  personally  take  charge  of 
conducting  parties  of  fifty  children  at  a  time,  to  those 
sea  resorts  where  properly  fitted  houses  have  been  built 
with  the  charitable  contributions  of  people  of  means. 
The  successful  results  of  such  treatment  have  been 
marvellous,  so  much  so  that  with  similar  success  another 
institution  was  started  later  with  the  purpose  of  combin- 
ing the  seashore  and  mountain  treatment. 

There  are  on  the  Riviera  also,  several  establishments 
for  heliotherapy,  the  treatment  of  diseases  by  exposing 
the  body  to  the  sun's  rays.  This  therapeutic  use  of  the 
sun-bath  has  acquired  public  favor  of  late.  Well  man- 
aged and  properly  applied,  heliotherapy  has  given 
some  remarkable  successes,  and  there  is  no  doubt  that 
there  is  a  great  future  for  this  modern  therapeutic 
treatment. 


12 


Chapter  XIX 
THE  UNIVERSITY  OF  PISA 

PISA  of  today,  a  peaceful,  quiet,  provincial  town 
of  about  70,000  souls,  does  not  look  like  the 
city  which  a  thousand  years  ago  was  the  birth- 
place of  proud  and  intrepid  crusaders  who 
proved  their  valor  at  the  capture  of  Jerusalem. 
History  further  recalls  the  great  power  which  the  Pisans 
acquired  in  wars  with  their  neighbors,  the  Lucchese 
and  the  Genoese,  and  with  the  Moslems,  who  had 
invaded  part  of  Europe.  It  was  in  the  year  11 15, 
that  a  fleet  of  three  hundred  sail,  commanded  by  Arch- 
bishop Pietro  Moriconi,  defeated  the  Moslems,  strongly 
intrenched  in  the  Baleari  Isles,  liberating  a  score  of 
Christian  prisoners.  History  likewise  recounts  the  long 
struggle  with  the  republic  of  Genoa,  rising  to  a  period 
of  wealth  and  prosperity,  of  which  abundant  monu- 
ments remain  today  in  the  magnificent  churches  and 
palaces  and  precious  objects  of  art. 

The  wealth  of  Pisa,  the  ambition  of  its  inhabitants, 
the  jealousy  of  its  neighbors,  kept  the  republic  in  a 
continual  state  of  war  with  its  rivals,  Lucca,  Genoa  and 
Florence,  until  the  defeat  of  the  Ghibelline  party  (which 
Pisa  had  joined  and  always  supported)  and  the  death 
of  Corradino,  its  sponsor,  not  only  started  the  decline 
of  the  Pisan  supremacy,  but  prepared  its  final  ruin  with 
the  loss  in  1284  of  the  battle  of  Meloria,  in  which  Genoa 
crushed  forever  its  rival.  A  brief  spark  of  old  glory 
returned  in  13 15,  with  Uguccione  della  Faggiuola,  and 

178 


THE  UNIVERSITY  OF  PISA  179 

later  on  (1328)  with  Castruccio  Castracane;  but  they 
were  sparks  of  a  dying  power. 

Could  Dante  see  Pisa  today,  he  would  not  think  the 
Pisans  as  bad  as  he  considered  them  in  his  thirty-third 
canto  of  the  "Inferno."  On  the  contrary,  he  would  find 
the  noble  Tuscan  city  a  peaceful,  industrious  and  pros- 
perous community  which,  in  the  last  twenty  years,  has 
almost  doubled  its  population.  Industries  of  many 
kinds,  especially  of  cotton  goods,  have  increased  its 
population  and  its  wealth,  and,  since  with  Italy  united 
there  will  be  none  of  the  old  rivalry  with  Lucca,  Genoa, 
Florence  or  Siena,  its  industrial  development  and  prog- 
ress will  be  uninterrupted  in  the  future. 

Few  cities  in  the  world  can  boast  such  an  honor  as 
the  birth  of  Galileo  Galilei,  who  in  his  youth  studied 
and  taught  in  his  native  city. 

Few  universities  of  Italy  have  had  so  many  ups  and 
downs  as  that  of  Pisa  since  its  foundation  in  the 
twelfth  century.  But  after  the  final  annexation  to 
Italy  in  1859,  it  began  to  revive,  and  in  1880  its  medical 
school  was  reorganized  on  a  basis  equal  to  the  other 
Italian  schools. 

The  names  of  Vittorio  Aducco  (physiologist),  Gugli- 
elmo  Romiti  (anatomist),  Giuseppe  Guarnieri  (bacteri- 
ologist), Guido  Ferrarini  and  Rinaldo  Cassanello 
(special  surgical  pathologists),  and  above  all  that  of 
Antonio  Ceci  (professor  of  clinical  and  operative 
surgery),  all  well  known  in  the  scientific  medical  world 
not  only  in  Italy  but  in  all  Europe,  are  sufficient  author- 
ity for  the  very  high  standing  of  Pisa's  surgical  school. 

The  surgical  clinic  of  Pisa,  in  fact,  is  one  of  the  most 
complete  and  well  equipped  in  Italy,  and  its  director, 


180  MODERN  ITALIAN  SURGERY 

Prof.  Antonio  Ceci  was  one  of  the  most  efficient  and 
active  teachers  known,  particularly  for  his  valuable 
participation  in  every  surgical  congress.  His  large 
contribution  to  the  literature  of  surgery  includes  some 
original  work  on  "The  Metallic  Suture  of  the  Patella" 
(1887),  "Splenectomy"  (1894),  "Removal  of  the  Sac 
in  Popliteal  Aneurysm"  (1808),  "The  Original 
Proposition  of  Ligating  the  Internal  Jugular  in  Cases 
Where  the  Primitive  Carotid  Has  to  be  Ligated, 
with  the  Purpose  of  Maintaining  the  Endocerebral 
Equilibrium." 

Professor  Ceci  devoted  his  talent  especially  to  plastic 
surgery,  in  which  he  had  remarkable  success,  and  as 
far  back  as  1900  he  adopted  and  practiced  the  original 
method  of  Vanghetti  for  cinematic  amputations, 
utilizing  the  muscular  stump  as  loops  for  future 
prosthetic  applications.  At  the  Surgical  Congress  of 
Bologna  (191 7)  he  strongly  upheld  the  original  ideas 
of  Vanghetti  as  practically  and  successfully  applied 
in  Italy  by  himself,  and  exhibited  cases  of  facial  plastic 
surgery,  presenting  his  original  studies  on  the  "Gradual 
Autonomic  Tendencies  of  Flaps  in  Reconstructive 
Surgery."  Besides  his  scientific  achievements,  Professor 
Ceci  has  turned  out  some  excellent  and  distinguished 
pupils  who  occupy  prominent  positions  in  various 
hospitals  in  Italy. 

The  Institute  of  Surgical  Pathology  is  directed  by 
Professor  Ferrarini,  a  pupil  of  Iginio  Tansini  of  Pavia, 
author  of  many  important  experimental  studies  which 
give  promise  of  a  successful  career. 

Forty  miles  from  Pisa,  in  one  of  the  prettiest  places 
in  Tuscany,  the  so-called  Valley  of  the  "Nievole,"  is 


THE  UNIVERSITY  OF  PISA  181 

Monte  Catini.  It  is  called  the  Italian  Carlsbad,  and  is 
the  most  noted  saline  springs  in  Italy.  Monte  Catini  is 
the  most  attractive  health  resort  in  all  Tuscany, 
especially  in  spring  and  autumn;  and  the  facility  of 
communication  makes  it  easy  and  convenient  to 
reach  the  place  from  Florence,  Pisa  and  Lucca,  in  fact, 
from  Rome  and  Genoa,  since  it  is  only  a  few  hours  by 
rail  from  each  city. 

The  fertile  surrounding  country  and  the  nearby 
Apennines  provide  excursions  full  of  interest,  and  the 
numerous  and  sumptuous  hotels  and  the  magnificent 
villas  scattered  all  over,  make  it  the  favorite  resort  of 
the  aristocracy  of  title  and  wealth.  Charitable  public 
institutions  amply  supply  the  means  of  relieving  also 
the  poor,  suffering  from  the  ailments  for  which  the 
springs  are  recommended — principally  intestinal, 
stomach,  and  liver  diseases. 

Less  than  three  miles  distant,  is  a  wonderful  natural 
grotto  called  "Monsummano,"  renowned  all  over  the 
world  for  its  efficacy  in  rheumatism,  being  a  natural 
steam  bath  of  medicinal  properties. 


Chapter  XX 
THE  UNIVERSITY  OF  SIENA 

AFTER  reading  the  history  of  Siena,  one  cannot 
visit  that  noble  city  without  the  highest  sense 
of  reverence  and  admiration.  On  April  21, 
1555,  the  Spanish  troops,  commanded 
by  the  Marquis  of  Marignano,  entered  the  gates 
of  Siena  after  a  year  of  siege,  during  which  the 
town  was  reduced  to  extremities,  and  was  forced  to 
capitulate  to  the  overwhelming  army  of  Emperor 
Charles  v.  It  was  a  year  of  fighting  and  starvation, 
indescribable  and  unsurpassed  in  history.  Only  after 
the  Sienese  had  lost  most  of  their  men  able  to  bear 
arms  and  their  women  too,  who  had  worked  and 
fought  in  ditch  and  on  rampart;  after  they  had  ejected 
the  aged  and  infirm  and  all  their  children  from  their 
gates,  to  die  upon  the  bayonets  of  the  enemy;  after  they 
had  eaten  the  last  blade  of  grass  within  the  walls — only 
then  the  city  surrendered.  Of  the  40,000  citizens,  only 
6,000,  specters  of  humanity,  dragged  their  emaciated 
bodies  across  the  barren  hills  to  Montalcino,  where  those 
glorious  survivors  maintained  a  shadowy  form  of  a 
republic  for  a  few  years. 

Siena  was  annihilated,  after  centuries  of  glorious 
achievement  in  science,  art,  industry,  under  a  liberal 
Government;  it  did  not  rise  again  until  another  liberal 
Government,  three  hundred  and  four  years  after  that 
glorious  fall,  annexed  the  city  to  the  new  Italy,  April  30, 
1859.  Since  then  the  University  of  Siena  has  made  rapid 
and  wonderful  progress. 

182 


THE  UNIVERSITY  OF  SIENA  183 

The  surgical  clinic  of  Siena  owes  most  of  its  present 
reputation  to  Prof.  Domenico  Biondi,  whose  untimely 
death,  only  a  few  years  ago,  deprived  the  University  of 
Siena  of  one  of  the  most  distinguished  members  of  the 
medical  school. 

Professor  Biondi,  originally  a  pupil  of  Carlo  Gallozzi 
and  Antonino  D'Antona,  both,  successively,  professor 
of  the  surgical  clinic  of  Naples,  completed  his  studies  in 
the  clinics  of  Vienna,  Leipzig,  Halle,  Berlin  and  St. 
Petersburg,  and  taught  histology  at  the  Physiological 
Institute  of  Breslau,  where  he  made  special  studies  and 
published  original  works  on  the  blood  and  on  the  thyroid 
gland.  He  returned  to  Italy,  called  there  to  direct  the 
surgical  clinic  of  Cagliari,  where  he  remained  eight 
years,  being  promoted  to  Siena  in  1899,  where- he  died 
(191 5).  His  scientific  productions  are  both  varied  and 
important,  and  as  it  would  take  too  long  to  review  all  of 
them,  mention  will  be  made  here  only  of  the  most 
notable.  In  1882,  he  published  a  work  on  the  experi- 
mental resection  and  total  extirpation  of  the  lung;  in 
1885-87,  he  published  a  complete  study,  review,  and 
development  of  spermatozoons  and  spermatogenesis, 
studied  by  means  of  the  comparative  histology  of  the 
testicle,  in  different  degrees  of  formation,  in  rats,  bulls, 
dogs,  rabbits,  pigs,  monkeys,  antelopes  and  frogs.  This 
study  showed  that  in  the  canaliculus  (spermatic)  there 
is  only  one  variety  of  epithelial  cell,  the  seminal,  from 
which  nucleus  the  spermatozoon  is  derived. 

Biondi's  researches  on  the  streptococcus,  on  pus,  and 
on  blood,  especially  the  last,  are  very  important.  Well 
known  is  the  method  of  staining  which  goes  by  his  name, 
a  reactive  made  of  acid  fuchsin,  orange  and  methyl  green. 

Among  Biondi's  works  on  embryology  there  are  some 


184  MODERN  ITALIAN  SURGERY 

on  the  congenital  fissure  of  the  lips  and  cheeks,  and  on  the 
embryological  formation  of  the  face,  which  are  recorded 
in    every    textbook.   He  was   also  the  first  to  deter- 
mine the  exact  function  of  the  thyroid  gland  (1891). 
In  his  publications  on  pathology  and  clinical  surgery, 
which  number  more  than  seventy,  Biondi  touches  upon 
almost  every  subject  in  surgery.  Among  these,  especially 
worthy  of  note,  are:  "Contributions  to  the  Surgery  of 
the    Lungs"     (1895);     "Experimental     Intrathoracic 
Esophagogastrostomy"    (1895);    "Clinical    Contribu- 
tions   to    the    Surgery    of    the    Pancreas"     (1897), 
accompanied  by  the  history  of  a  case  of  extirpation 
of  the  head  of  the  pancreas  for  benignant  tumor,  suc- 
cessfully cured;  also  a  contribution  to  endo-oral  plas- 
tic surgery  (by  a  special  method);  special  method  of 
fixation   of  the   movable   kidney  with   a  gauze-band 
around  the  organ  placed  in  normal  position;  clinical 
notes  on  8  cases  of  operation  on  the  spinal  cord  (1900); 
notes  on  purulent  peritonitis   (1902);  statistics,  with 
discussion  of  464  cases  of  appendicitis   ( 1904-19 12); 
contribution  to  the  cure  of  echinococcus  of  the  liver 
(1905)  by  a  special  method,  consisting  of  laparotomy, 
partial  evacuation  of  the  cyst  with  a  capillary  trocar, 
and  injection  of  20  c.c.  of  1:1,000  solution  of  silver 
fluoride,  with  occlusion  of  the  puncture  and  of  the 
abdomen  (a  treatment  used  successfully  in  20  cases). 
He  also  published  articles  on  the  treatment  of  the  tuber- 
culous spermatic  duct  with  injections  into  the  deferent 
duct  (1908);  gastric  surgery,  with  54  cases  of  posterior 
vertical  gastro-enterostomy,  9  cases  of  pyloric  occlusion 
by  a  special  method,   11  cases  of  total  gastrectomies 
and  1 0  cases  of  total  cholecystectomy. 


THE  UNIVERSITY  OF  SIENA  185 

Biondi's  fine  and  efficient  method  of  teaching  pro- 
duced some  very  able  pupils  who  do  honor  to  their 
master,  and  during  his  period  of  tuition  more  than  two 
hundred  important  surgical  pamphlets  were  published 
by  several  of  his  students. 

Biondi's  worthy  successor  is  at  present  Prof.  Vittorio 
Remedi,  a  pupil  of  Professor  Novaro,  who  follows  in 
the  footsteps  of  his  celebrated  master.  His  publications 
are  not  as  yet  numerous,  but  very  important:  "Con- 
genital Papilloma  of  the  Tongue"  (1891);  "Hemato- 
Iymphangioma"  (1897);  a  very  good  work  on  hernia, 
especially  of  the  inguinal  oblique,  which,  in  a  great 
majority  of  cases,  according  to  his  experience,  is 
congenital  (1893).  Later  he  described  particularly  the 
different  proceedings  of  Bassini's  method,  suggesting 
some  personal  modifications  (1904).  He  has  to  his  credit 
some  notable  contributions  on  the  surgery  of  the  biliary 
canals  and  on  that  of  the  pancreas,  dwelling  extensively 
on  2  cases  of  suppurative  pancreatitis.  An  interesting 
study  is  his  article  on  the  histology  of  the  mucous 
membrane  in  exstrophy  of  the  bladder,  in  which  he 
describes  the  alteration  of  the  vesical  epithelium,  and 
the  neoformation  of  the  glands,  in  a  particular  case. 

But  especially  worthy  of  consideration  are  Remedi's 
experiments  on  the  antitoxic  influence  of  the  thyroid 
gland  on  tetanic  poison,  experiments  which  prove 
that  the  poison  of  tetanus  loses  its  toxic  power  in  the 
thyroid. 

The  Institute  of  Surgical  Pathology  is  directed  by  a 
young  but  able  pathologist,  Prof.  Domenico  Taddei, 
a  pupil  of  a  most  distinguished  teacher,  Prof.  Enrico 
Burci  of  Florence. 


186  MODERN  ITALIAN  SURGERY 

Professor  Taddei's  success  corresponds  to  the  splendid 
scientific  preparation  he  had  under  Prof.  Burci,  and 
his  scientific  productions  show  already  the  advantages 
he  gained  from  his  clinical  and  laboratory  education. 
Here  follows  a  list  of  his  publications:  "Hemo- 
angiosarcoma  Endothelials  of  the  Tonsils"  (1900); 
"Angioma  of  the  Breast"  (1904);  "Renal  Hematuria" 
(1907);  "Fracture  of  the  Epistropheus  Without  Med- 
ullary Symptoms"  (19 12);  "Supercecal  Stenosis  and 
Movable  Kidney"  (1914);  "Contribution  to  the  Study 
of  Spina  Bifida"  (1906);  "Contribution  to  the  Patho- 
genesis of  Cystic  Kidney"  (1908);  "Pathology  and 
Clinical  Course  of  Kidney  Tumors"  (1908);  "Contribu- 
tion to  the  Study  of  the  Plexiform  Neuroma"  (1913); 
"Contribution  to  the  Study  of  Subcutaneous  Lesions 
of  Some  Viscera — Spleen,  Choledochus,  and  Small  Intes- 
tine" (1914). 

In  a  publication  (1901),  repeated  in  191 7,  Taddei 
favors  the  lateral  partial  ligature  of  the  veins  with  silk, 
without  compromising  their  functions,  presenting  a  few 
clinical  cases  of  the  kind.  He  also  brings  out  the  results 
of  the  use  of  Burci's  method  in  the  resection  of  the  liver, 
a  proceeding  applied  with  success  in  a  case  of  splenec- 
tomy with  adherent  spleen  in  a  malaria  subject  (1901- 
19 15).  Other  publications  are  his  researches  on  the 
histological  modification  of  the  ureter  after  nephrec- 
tomy (1914),  the  genesis  of  elastic  fibers  in  cicatrices 
(1903- 1 905),  the  effect  of  large  adhesions  of  the  omen- 
tum on  a  decapsulated  kidney  (1907),  the  grafting  of 
the  suprarenal  capsule  on  the  kidney  (1907);  the  result 
of  Iigating  the  artery  and  vein  emulgent  in  kidneys 
previously  decapsulated  and  covered  with  omentum 


THE  UNIVERSITY  OF  SIENA  187 

(1908) ;  the  total  extirpation  of  the  mucous  membrane  of 
the  bladder  (191 2),  etc.  His  essay  on  wounds  produced 
by  modern  guns  attracted  the  attention  of  military 
surgeons. 

Taddei  is  now  editing  a  treatise  on  semeiotic  surgery, 
which,  from  the  chapters  already  published,  promises 
to  be  an  excellent  work. 

Notwithstanding  the  political  vicissitudes  and 
struggles  which  in  many  centuries  kept  Siena  oscillat- 
ing between  the  extremes  of  power  and  submission, 
and,  from  a  prosperous  city  of  more  than  100,000 
inhabitants,  reduced  it  to  a  small  town  of  a  little  more 
than  20,000  (the  population  of  today),  yet  the  immense 
treasures  of  art  are  still  there,  almost  intact,  and  claim 
for  Siena  the  title  of  "The  Jewel  of  Tuscany/ 

Every  palace  is  a  monument  and  a  model  for  study, 
every  hospital  has  some  work  of  art  attached  to  it. 
Most  of  the  buildings  carry  with  the  name  of  a  cele- 
brated artist,  some  historical  remembrance.  There  is  no 
place  in  Tuscany,  and  perhaps  in  all  Italy,  so  fascinating, 
so  attractive,  so  hospitable;  no  place  so  full  of  tourists  in 
search  of  mental  relaxation,  useful  education  and 
pleasant  physical  rest. 


Chapter  XXI 
THE  INSTITUTES  OF  FLORENCE 

THAT  Florence  should  be  called  the  garden  of 
Italy,  is  not  suprising,  for  Tuscany,  of  which 
Florence  is  the  capital,  is  one  of  the  most  fa- 
vored regions  of  Italy. 

The  climate  is  temperate  and  the  rainfall  not  exces- 
sive; the  Apennines  shelter  it  from  the  cold  north 
winds  and  the  prevailing  winds  of  the  west.  The  fertility 
of  its  soil  is  famous  and  its  mineral  resources  are  well 
known,  as  also  are  its  industries,  which  have  greatly 
developed  of  late. 

Since  the  union  with  Italy  in  1859,  Tuscany  has 
ceased  to  constitute  a  separate  political  entity,  although 
the  people  still  preserve  definite  regional  characteristics. 
The  territory  has  increased  in  wealth  and  education, 
and  owing  to  a  good  system  of  land  tenure,  the  peas- 
antry is  among  the  most  prosperous  in  Italy. 

What  is  said  of  Tuscany,  can  be  repeated  of  Florence, 
with  the  addition  of  almost  a  thousand  years  of  civiliza- 
tion, so  that  notwithstanding  its  many  conflicts,  its 
ups  and  downs  of  power,  the  city  has  always  been 
considered  the  center  of  art,  science  and  culture,  and 
is  today  still  recognized  as  such  by  the  whole  world. 

Dante,  Michelangelo,  Giotto,  Fra  Angelico,  Benozzo 
Gozzoli  and  an  almost  endless  chain  of  familiar  names, 
with  the  beautiful  monuments  and  collections  of  art 
and  scientific  documents,  are  in  the  minds,  before  the 
eyes  and  in  the  hearts  of  millions  of  people.  And  millions 

188 


THE  INSTITUTES  OF  FLORENCE  189 

more  in  the  future  will  go  to  Florence  to  visit,  to  see,  to 
study,  to  learn  amidst  such  an  enormous  wealth  of 
treasures. 

But  of  the  Florence  of  today,  of  the  glorious  revival 
of  science,  of  art,  of  industry,  which  has  given  such  a 
splendid  example  to  the  rest  of  Italy,  and  to  the  world, 
since  its  annexation  to  the  new  kingdom  of  Italy  in 
1859,  no  mention  is  made  in  the  many  books  written 
to  glorify  a  past,  which  is  beautiful,  great  and  precious, 
but  is  not  the  life  of  today,  the  hope  of  tomorrow,  the 
pride  of  the  future. 

Florence  today  is  a  center  for  the  study  of  philosophy 
and  philology;  of  physics  and  natural  sciences;  of 
medicine  and  surgery.  It  has  an  institute  of  social 
sciences;  one  of  fine  arts;  one  of  astronomy;  one  of 
geography;  one  of  public  hygiene;  one  of  anthropology ; 
and  many  others,  all  of  which  are  well  supplied  with 
competent  instructors  and  frequented  by  numerous 
classes  of  students. 

The  Institute  of  Medicine  and  Surgery  is  flourishing 
and  is  directed  by  some  of  the  best  teachers  of  Italy, 
notable  among  whom  are  Giulio  Chiarugi,  professor 
of  anatomy;  Alessandro  Lustig,  professor  of  general 
pathology;  Guido  Banti,  professor  of  pathologic  anat- 
omy, and  Enrico  Burci,  professor  of  clinical  and  opera- 
tive surgery. 

The  surgical  clinic  of  the  Institute  has  had  a  very 
enviable  reputation,  first  with  Giuseppe  Corradi,  who, 
after  a  score  of  years  of  a  brilliant  career,  and  notable 
publications  on  several  subjects,  especially  in  urology, 
left  the  chair  to  Francesco  Colzi  in  1894.  He  made  a 
large  contribution  to  scientific  surgery,  including  an 


ipo  MODERN  ITALIAN  SURGERY 

original   description   on   cholecystenterostomy,    erron- 
eously bearing  the  name  of  "Winiwarter's  Operation." 

An  unfortunate  accident  cut  short  the  life  of  this 
promising  surgeon  and  teacher,  but  his  place  was  well 
filled  by  a  young  man,  Prof.  Enrico  Burci. 

The  work  of  Burci  deserves  consideration,  for  his 
practical  surgical  work  is  always  conducive  to  the 
scientific  study  of  pathology. 

His  studies  on  the  suture  of  the  arteries,  on  the  trau- 
matic lesions  of  the  arterial  layer  and  the  possibility 
of  denuding  an  extensive  tract  of  a  large  arterial 
vessel  without  serious  consequences,  on  the  grafting 
of  veins  with  suture,  on  a  particular  technique  for  opera- 
tions on  the  intestines,  on  a  special  enterostomy  for 
enterostasis  of  the  intestine,  on  experimental  researches 
for  extraperitoneal  splenopexy,  on  decapsulation  of 
the  kidney,  on  resection  of  the  liver  for  echinococcus, 
on  suppurative  nephritis,  and  on  the  application  of 
elastic  ligature  in  partial  resection  of  the  liver  are 
well  known  in  Italy,  and  have  also  been  reproduced 
in  foreign  medical  journals. 

Professor  Burci  distinguished  himself  during  the  war 
for  the  efficiency  with  which  he  conducted  the  work  of 
supervision  of  convalescents,  a  delicate  and  highly 
responsible  position  which  gained  for  him  recognition 
and  praise. 

The  Institute  of  Surgical  Pathology  is  directed  by 
Prof.  Gerolamo  Gatti,  who  also  has  charge  of  the 
Surgical  Pediatric  Clinic.  He  is  the  author  of  several 
publications  on  pathology;  one  of  these  (1896),  re- 
printed in  the  Langenbeck  Archives,  deals  with  the  heal- 
ing process  of  peritoneal  tuberculosis,  with  a  histo- 


THE  INSTITUTES  OF  FLORENCE  191 

logical  study  of  the  subject;  another  discusses  cutaneous 
sarcomatosis  and  double  decapsulation  of  the  kidneys 
in  chronic  nephritis;  another,  the  new  method  of  funic- 
ulo-abdominal  hysteropexy.  He  has  contributed  many 
articles  on  surgery  in  children,  including  a  monograph 
on  umbilical  hernia  in  infancy  (1914),  with  statistics 
of  1,349  cases  observed  in  thirteen  years,  in  the  Pedia- 
tric Clinic,  in  children  under  ten  years  of  age. 

Special  mention  must  be  made  here  of  Dr.  Theodoro 
Stori,  who  is  considered  the  leading  surgeon  of  Tuscany, 
as  his  very  large  practice  and  the  high  esteem  he  enjoys 
among  his  colleagues  amply  proves. 

Florence  has  several  surgical  sections  in  the  various 
hospitals,  where  the  latest  equipment  and  appliances  are 
always  found.  One  of  these  deserves  special  mention, 
being  directed  by  Prof.  Nicola  Giannettasio,  who  dis- 
tinguished himself  during  the  war  as  director  of  a  sur- 
gical section  at  the  front,  where  splendid  results  were 
obtained  by  his  own  technique  in  operations  and  wound 
dressing. 

Florence  has  also  a  Medical  Military  School  founded 
in  1882,  which  is  a  kind  of  post-graduate  school  to 
prepare  physicians  for  the  army;  this  institution  is 
like  a  military  university,  where  the  students  are 
taught  war  traumatology,  legal  military  medicine, 
military  service  and  hygiene,  microbiology,  epidemiol- 
ogy, chemistry  applied  to  hygiene,  stomatology, 
and  other  laboratory  courses  for  extending  their 
knowledge. 


Chapter  XXII 
THE  UNIVERSITY  OF  NAPLES 

THE  University  of  Naples  was  founded  in 
the  twelfth  century  by  Frederick  11,  but  its 
school  of  medicine  did  not  rise  to  great 
importance,  perhaps  on  account  of  the 
School  of  Salerno  which  was  known  as  early  as  the 
ninth  century,  and  as  "Civita  Hippocratica"  held  a 
prominent  position  in  medieval  times,  being  considered 
the  great  seat  of  learning  in  Italy. 

The  School  of  Salerno  was  elevated  to  the  dignity 
of  a  university  in  1 150  and  was  closed  in  the  beginning  of 
last  century,  in  the  year  181 7.  As  Salerno  is  only  about 
thirty-four  miles  from  Naples,  its  ancient  reputation 
attracted  the  bulk  of  the  students,  leaving  the  medical 
school  of  Naples  rather  neglected.  The  political  strug- 
gles which  upset  the  internal  conditions  of  the  big  city, 
also  kept  Naples  from  developing  its  scientific  institu- 
tions properly.  But  Naples  of  today,  the  largest  city  of 
the  new  Italy,  with  its  650,000  inhabitants,  surprises 
the  visitor  by  its  great  progress  made  since  1861,  after 
the  Southern  States,  thanks  to  the  wonderful  and  rapid 
conquest  of  Garibaldi,  were  annexed  to  the  kingdom 
of  Italy. 

A  wise  and  prompt  reorganization  placed  the  Univer- 
sity of  Naples  as  the  center  of  learning  of  a  population 
of  almost  fourteen  millions  of  people — the  entire  southern 
part  of  Italy.  The  university,  a  structure  dating  back 
to  1605,  reconstructed  in  1780,  is  an  imposing  building, 

192 


THE  UNIVERSITY  OF  NAPLES  193 

to  which  lately  has  been  added  some  modern  labora- 
tories, equipped  with  all  the  modern  improvements 
that  science  could  suggest,  including  new  anatomic 
and  pathologic  institutes  and  clinics. 

The  university  is  attended  at  present  by  more  than 
5,000  students  and  has  a  library  of  400,000  volumes. 

The  courtyard  contains  a  few  busts  (including  a 
fine  one  of  the  great  poet  Giacomo  Leopardi)  and  the 
statues  of  Pier  della  Vigna,  secretary  to  Frederick  11 
(one  of  the  legislators  of  his  time),  of  Thomas  Aquinas, 
the  Neapolitan  philosopher  of  the  twelfth  century,  the 
learned  Dominican  monk  of  Monte  Cassino,  whose 
works  were  published  at  the  expense  of  Pope  Leo  xin  in 
1903,  and  of  Giovanni  Battista  Vico,  the  Italian  jurist  of 
the  sixteenth  century.  Among  the  remarkable  books 
which  Vico  published,  two  stand  as  texts  of  the  highest 
intellect:  "De  Antiquissima  Italorum  Sapientia"  (1710) 
and  "De  Universi  Juris  Uno  Principio  et  Fine  Uno" 
(1720).  The  courtyard  also  contains  the  statue  of  Gior- 
dano Bruno,  the  Italian  philosopher  of  the  Renaissance, 
who  among  his  many  metaphysical  works  in  1584 
published  "Cena  Delle  Ceneri"  (Ash  Wednesday 
Conversations)  devoted  to  an  exposition  of  the  Coper- 
nican  theory. 

An  extensive  new  university  building  has  been  con- 
structed in  the  Corso  Umberto  Primo. 

The  University  of  Naples,  on  account  of  the  large 
concourse  of  students,  has  a  larger  staff  than  any  other 
university  of  Italy.  The  medicochirurgical  faculty 
counts  among  its  professors  and  assistants  some  of  the 
ablest  surgeons  and  docents  in  surgical  tuition  that 
could  be  secured. 

13 


194  MODERN  ITALIAN  SURGERY 

The  modern  reputation  of  the  surgical  school  of 
Naples  is  due  especially  to  the  lamented  Prof.  Carlo 
Gallozzi,  who  left  many  scientific  publications,  including 
an  important  treatise  on  operative  surgery — a  textbook 
for  students  and  practitioners  of  the  middle  of  the  last 
century. 

After  a  long  period  of  teaching,  Professor  Gallozzi  was 
succeeded  by  Prof.  Antonino  D'Antona,  who  died  in 
19 1 3,  leaving  a  large  contribution  to  the  scientific 
literature  on  surgery,  and  the  well-deserved  reputation 
of  one  of  the  most  skillful  and  successful  surgeons  of 
modern  Italy.  He  was  a  pupil  of  Gallozzi,  also  of 
Virchow,  von  Langenbeck,  Spencer- Wells  and  Billroth, 
and  he  used  his  ability  and  wide  experience  in  trying 
to  free  surgery  from  that  empiricism  which  was  still 
prevalent  in  the  middle  of  the  last  century,  particularly 
in  the  south.  Being  essentially  a  student  of  pathology, 
he  always  applied  it  to  practical  surgery,  and  in  all  his 
numerous  publications  he  always  united  his  surgical 
studies  with  his  knowledge  of  pathology,  as  illustrated  in 
"Surgical  Pathology  of  the  Blood-Vessels,"  "Physio- 
pathology  of  Contracture,"  "Ulcerative  Inflammatory 
Processes,"  "Common  Acute  Surgical  Infections,"  and 
two  big  volumes  on  the  surgery  of  the  central  nervous 
system.  At  the  end  of  his  useful  career  he  published 
some  original  treatises  on  surgical  tuberculosis,  especially 
in  reference  to  abdominal  tuberculosis.  He  provided 
the  clinic  with  a  very  modern  laboratory  and  a  rich 
library  of  useful  books  and  magazines. 

Professor  D'Antona  was  considered  one  of  the  best 
operators  and  one  of  the  best  instructors  of  his  time,  his 
many  pupils  attesting  to  his  worth  as  a  teacher.  Among 


THE  UNIVERSITY  OF  NAPLES  195 

these  is  the  present  incumbent,  Prof.  Giovanni  Pascale, 
who  has  followed  intelligently  the  noble  traditions 
of  his  teacher  with  some  interesting  publications  on 
experiments  in  bone  graft,  conservative  surgery  in 
tumors  of  the  scapula  (1904),  primitive  myxofibroma 
of  the  vermiform  appendix,  surgical  intervention  in 
traumatic  facial  paralysis,  spinofacial  anastomosis  for 
the  first  time  successfully  done  in  Italy  (1906),  treat- 
ment of  aneurysm  with  removal  of  the  sac,  operative 
technique  in  prostatic  hypertrophy,  operation  by  cut- 
ting the  inferior  calcaneoscaphoid  ligament  in  place  of 
Phelps'  operation,  and  decortication  of  the  lung  for 
chronic  empyema. 

To  form  a  correct  conception  of  the  conspicuous  work 
done  at  the  surgical  clinic  of  the  University  of  Naples, 
one  has  to  read  the  large  and  complete  report  made  by 
Professor  Pascale's  predecessor  and  teacher,  Prof. 
Antonino  D'Antona,  "  Rendiconto  Scientifico  Clinico  del 
Quinquennio  (1905-1909),"  in  which  are  documented 
all  the  marvellous  activities  of  the  school  during  that 
period. 

Some  of  the  other  pupils  of  Professor  D'Antona,  who 
are  distinguishing  themselves  in  their  work  and  by 
means  of  publications,  are  the  free  docents — Rocco 
Camminiti,  who  has  published  a  treatise  on  prostatic 
hypertrophy  and  sacro-iliac  resection;  Luigi  de  Gaetano 
on  hepatic  wounds;  and  Filiberto  Jacobelli  and  Leopoldo 
Rizzo  on  other  original  subjects. 

Mention  must  be  made  here  of  Prof.  Angelo  Roth, 
who,  for  a  short  time  before  his  premature  death,  held 
the  chair  of  special  surgical  pathology  in  which  he 
distinguished    himself.    He    had    previously    held    the 


i96  MODERN  ITALIAN  SURGERY 

chair  of  surgical  pathology  in  Sassari,  in  his  native 
island  of  Sardinia. 

Independent  of  the  Clinic,  there  is  also  the  "  Istituto 
di  Medicina  Operatoria,"  under  Prof.  Fabrizio  Padula, 
who  has  made  some  useful  studies  upon  cranial  surgery, 
and  the  surgical  anatomy  of  the  limbs. 

Naples  has  many  large  hospitals,  where  some  very 
able  surgeons,  following  the  school  of  Gallozzi,  D'Antona 
and  Pascale,  and  some  from  the  other  universities  of 
Italy,  favored  beside  by  the  advantage  of  observations 
in  other  clinics  at  home  and  in  foreign  country,  apply 
their  knowledge  and  ability  with  success  and  honor. 

The  foreign  visitor  is  so  accustomed  to  consider 
Naples  as  the  old  nest  of  "Lazzaroni,"  mandolin 
players  and  street  singers,  the  gay  "City  of  Eternal 
Idlers/'  that  it  is  difficult  to  convince  him  that  there  is 
a  modern  intellectual  city  full  of  thinking,  studious, 
ambitious  people,  eager  to  learn,  anxious  to  improve, 
to  advance  and  to  achieve  in  life's  higher  ideals.  Yet 
Naples  has  today  one  of  the  largest  universities  of  Italy, 
with  more  than  5,000  students,  most  of  them  from 
the  southern  regions,  all  following  the  regular  course  of 
each  faculty,  under  the  same  rigid  regulations  which  are 
the  standard  of  all  the  Italian  universities. 

The  contribution  that  Naples  has  made  to  the  unifi- 
cation of  Italy  in  the  way  of  men  of  high  standing  in 
science,  in  literature,  in  art,  in  politics,  and  in  every 
branch  of  the  professions,  is  larger  than  from  any  other 
part  of  the  country.  There  are,  at  present,  at  the  head  of 
the  Government  two  men  who  came  from  the  Uni- 
versity of  Naples,  which  has  given  to  the  country  so 
many  prominent  patriots  and  leaders.  These  two  men, 


THE  UNIVERSITY  OF  NAPLES  197 

Benedetto  Croce,  the  great  philosopher,  and  Arturo 
Labriola,  the  well-known  revolutionary  socialist  and 
political  leader,  represent  in  their  writings  the  highest 
principles  of  social  agitation.  Recently  there  has  been 
before  the  public  in  Europe,  Francesco  Nitti,  the  Prime 
Minister,  who  also,  as  a  professor  at  the  University  of 
Naples,  has  published  some  elaborate  works  on  finance 
and  political  economy. 

Modern  Naples  also  boasts  an  industrial  growth 
which  during  the  last  twenty  years  has  been  marvellous, 
and  is  rapidly  expanding.  It  manufactures  marine 
engines;  its  trade  in  hemp,  grown  in  the  surrounding 
country,  is  very  active,  while  liberal  inducements  offered 
by  the  Government  have  given  a  strong  impetus  to  all 
sorts  of  business  enterprises,  so  that  there  are  now  more 
than  one  hundred  industrial  establishments  at  work, 
including  cotton  and  jute  mills,  tanneries  and  chemical 
works.  Electric  power  is  brought  from  famous*,  River 
Lete,  fifty  miles  distant;  also  from  Popoli,  with  an 
85, 000- volt  current  (the  highest  in  Europe). 

The  iron  industry  stationed  at  Bagnoli  (Ilva  Works) 
smelts  200,000  tons  per  year;  another  at  Torre-Annun- 
ziata  smelts  half  that  amount,  deriving  ore  from  Elba. 
The  big  industrial  house  of  Armstrong  has  a  large 
ship-building  establishment  at  Pozzuoli,  and  a  similar 
one  exists  at  Torre-Annunziata.  It  is  impossible  to 
enumerate  the  thousands  of  enterprises  of  such  an 
active  population,  a  condition  which  promises  a  future 
of  prosperity  never  before  known. 

The  surroundings  of  Naples  are  beautiful  and  the 
excursions  to  Sorrento,  to  the  little  island  of  Capri, 
along  the  coast  of  the  Gulf  of  Salerno,  to  Amalfi,  Ravello, 


198  MODERN  ITALIAN  SURGERY 

Pestum,  are  so  well  known  that  a  further  description 
is  unnecessary. 

Of  the  many  health  resorts  near  Naples,  the  most 
popular  are,  first:  that  of  Castellamare  di  Stabia 
(Fontes  Stabioe,  celebrated  by  Pliny — in  agro  Stabiano 
aqua  quae  vocatur  dimidia,  calculosis  medetur,  and  by  Col- 
umella— fontibus  Stabioe  celebres),  which  are  very  highly 
recommended  for  glandular  diseases,  for  intestinal 
torpidity,  in  kidney  troubles  and  skin  affections. 
Castellamare  is  a  beautiful  city  on  the  gulf,  only  twenty 
miles  from  Naples,  one-half  hour  by  rail  or  car.  The 
second  is  the  famous  island  of  Ischia,  only  twenty  miles 
by  steamer  from  Naples.  Exposed  to  the  northerly  winds 
in  winter,  it  is  a  cool  summer  resort.  Near  the  little 
town  of  Ischia,  is  Casamicciola,  the  most  picturesque 
village,  in  which  the  most  famous  hot  baths  on  earth 
are  located.  Both  places  have  splendid  accommodations 
for  rich  and  poor,  and  the  efficacy  of  the  waters  has 
been  well  advertised  all  over  the  world. 

The  volcanic  surroundings  and  the  condition  of  the 
country  around  Vesuvius  explain  the  abundance  of 
health  resorts  adjacent  to  Naples.  In  fact,  besides  the 
famous  baths  of  Casamicciola,  recommended  for  all 
sorts  of  bone  affections,  chronic  rheumatism  and  skin 
trouble,  there  are,  almost  in  Naples  itself,  the  renowned 
baths  of  Chiatamone  and  those  of  Pozzuoli,  also  well 
provided  with  all  sorts  of  modern  equipment  for  the 
comfort  of  the  patients  who  throng  there  in  great  num- 
bers the  year  around  on  account  of  the  mild  climate  and 
the  natural  beauty  of  the  country. 


Chapter  XXIII 
THE  UNIVERSITIES  OF  SICILY 

OF  the  many  hundred  books  on  Sicily,  written 
in    almost    every    language,     only   two    are 
really   true   to    the   actual  character  of  the 
people,    the    peculiarity    of   the    masses,   the 
condition  of  the  country,  the  aspect  of  the  land.  Yet 
those  two  books  are  almost  unknown  and  perhaps  long 
forgotten  by  some  who  happened  to  read  them. 

One  was  written  many  years  ago  by  the  great  social 
writer  of  Sweden,  Selma  Lagerlof,  in  the  form  of  a 
novel,1  in  which  the  philosophy  of  a  noble  soul  is 
revealed — the  awakening  of  a  new  generation,  after 
centuries  of  profound  sleep,  is  vividly  described.  The 
other  was  written  by  the  candid  mind  of  Edmondo  De 
Amicis,  only  a  few  years  before  his  death.  One  is  a 
marvellous  description  of  that  feudalism,  which  has 
been  the  curse  of  all  the  southern  countries  of  Europe: 
a  feudalism  supported  by  the  profound  ignorance  of 
the  people,  debased  by  all  sorts  of  superstitions  and 
human  degradations.  The  unification  of  Italy,  the  liber- 
ation of  Sicily  from  the  despotism  of  the  Bourbons, 
which  Gladstone  described  as  "The  Negation  of  God 
Erected  into  the  Form  of  a  Government,"  awoke  the 
dormant  spirit  of  an  intelligent  and  bright  race,  crushed 
for  centuries  by  the  most  brutal  servitude. 

Not  until  i860  did  Garibaldi  break  the  yoke  of  their 

'Miracles  of  the  Anti-Christ.  English  trans,  by  P.  B.  Flach.  New  York, 
1909. 

199 


200  MODERN  ITALIAN  SURGERY 

bondage,  and  then,  for  the  first  time  in  many  centuries, 
the  Sicilians  were  free  to  work  out  their  social  and 
political  salvation. 

Selma  Lagerlof  describes  in  her  novel,  the  crucial 
time  of  that  awakening,  the  struggles  and  the  battles 
between  the  dense  fog  of  ignorance  and  the  light  of 
liberty,  trying,  by  means  of  its  apostles,  to  find  its  way 
through.  The  battle  is  still  going  on  today,  and  will 
perhaps  last  a  few  generations  more,  until,  at  least,  the 
last  sign  of  feudalism  is  eradicated  entirely,  and  broader 
education  has  relieved  and  uplifted  the  whole  country. 

The  tears  of  Edmondo  De  Amicis  on  the  tardy  pro- 
gress of  Sicily  have  an  echo  in  the  lamentations  of  the 
late  negro  educator,  Booker  T.  Washington,  who,  in 
his  love  for  his  race,  deprecates  with  bitterness  the 
slowness  of  the  American  people  in  educating  the  South, 
and  in  the  work  of  V.  Blasco  Ibanez,  who  looks  upon  his 
countrymen  with  contempt  because  of  their  antiquated 
customs  and  ideas.  Russia  of  today  could  give  some 
ideas  on  the  cost  of  rapid  evolution  in  a  country. 

The  Great  War,  which  has  caused  an  unparalled 
hurricane  throughout  a  world  of  civilization,  of  educa- 
tion, of  refinement  of  long  standing  such  as  Europe  was 
supposed  to  be,  centered  exactly  where  the  highest 
standard  of  human  progress  had  been  cultivated  to 
perfection.  But,  what  was  called  brigandage  in  Sicily,  in 
Spain,  nay,  in  the  Balkans  and  in  Morocco,  was  almost 
a  chivalrous,  passionate  vendetta,  compared  with  the 
assassinations  of  thousands  of  youths  by  deadly  gas,  of 
innocent  children  by  submarines;  the  torture,  rape, 
and  unmerciful  hanging  and  shooting  by  an  undis- 
ciplined  military   mob,    maddened   by  suffering  and 


THE  UNIVERSITIES  OF  SICILY  201 

the  beastly  instincts  of  nature  perverted  by  wrong 
influences  and  teachings. 

During  those  five  years  of  unbridled  violence,  human- 
ity committed  more  crimes  and  brutalities  than  were 
committed  in  the  past  centuries  by  the  Sicilians, 
Spaniards,  and  by  the  negroes  of  the  South.  But  human 
hypocrisy  will  call  the  first,  an  heroic  epoch  to  be 
written  in  the  history  of  the  world,  so  that,  in  future 
wars,  people  may  study  and  learn  of  the  great  deeds  of 
the  glory  of  the  past.  Meanwhile,  the  robbery  and  the 
misery  which  disgraced  humanity  during  those  same  five 
years  will  be  carefully  avoided  or  entirely  ignored. 

If  the  billions,  which  have  been  wasted  in  finding 
the  best  way  of  killing  men  and  destroying  what  was  the 
world's  pride  and  joy,  had  been  spent  in  educating  the 
South,  in  improving  Spain  (according  to  Ibanez),  and 
in  giving  to  Sicily  roads  and  division  of  the  land,  and 
to  the  Balkans  a  whiff  of  that  so  much  praised  human 
education,  progress  and  civilization — perhaps  the  world 
would  be  much  better  off  today. 

Sicily  has  been  neglected,  as  many  other  worthy 
countries  have  been  before,  and  are  still  neglected, 
because  of  the  unfortunate  force  of  circumstances. 
Nature's  fatalities,  and  sometimes  cruel,  hard  destiny, 
turn  a  flourishing  empire  to  ruin,  a  city  to  ashes,  and 
a  country  to  devastation.  But  man  remains,  the  race 
thrives,  traditions  cultivate  the  spirit  of  nationality, 
the  spark  of  a  new  life  rekindles  the  fire  of  a  new  era, 
history  writes  once  more  the  deeds  of  a  new  nation.  It 
is  the  world  over  and  over  again,  as  before. 

We  all  know  that  Sicily  has  been  the  field  of  many 
struggles  of  race  against  race,  nation  against  nation, 


202  MODERN  ITALIAN  SURGERY 

and  creed  against  creed.  Sicily  has  been  the  prey  of 
Phoenicians,  Semites,  Aryans,  Greeks,  Carthaginians, 
Romans,  Pagans,  Christians  and  Moslems,  who  made  it 
the  field  of  their  contests,  of  battles  and  of  successive 
domination  and  glory.  Later  the  Saracens,  the  Normans, 
the  Angevins  struggled  with  each  other  for  the  sake 
of  ruling  the  beautiful  country.  They  left  it  at  last 
dilapidated,  exhausted,  forgotten  in  the  hands  of  a 
corrupt  Government,  abandoned  to  all  sorts  of  super- 
stitions, lawlessness  and  misery,  until  Garibaldi,  in 
i860,  gave  to  the  island  its  freedom. 

The  use  that  Sicilians  have  made  of  that  freedom  has 
been  constant  but  slow,  on  account  of  the  feudal  system 
of  land  ownership  which  cannot  be  changed  rapidly 
without  dangerously  upsetting  the  social  method  of 
life  in  a  community.  When  Garibaldi  wrested  the 
island  from  the  yoke  of  the  Bourbons,  not  one  single 
mile  of  railroad  had  been  built.  The  island  was  infested 
by  brigands  and  90  per  cent  of  the  people  could  not 
read  or  write.  Today  all  the  principal  points  are  con- 
nected by  a  railway  system  similar  to  that  of  the  south 
of  Italy,  with  the  exception  of  the  branch  line  to  Cor- 
Ieone  and  around  Mount  Aetna.  Illiteracy  has  been 
reduced  to  25  per  cent,  which  is  more  than  remarkable 
when  the  peculiar  condition  of  the  country,  the  char- 
acter of  the  people,  the  political  and  social  circum- 
stances are  taken  into  account. 

The  socialistic  ideas,  which  were  introduced  despite 
the  bitter  opposition  of  the  capitalist,  landowners  and 
bigoted  clergy,  made  rapid  headway,  thanks  especially 
to  a  strong-minded  and  courageous  patriot,  Giuseppe  de 
Felice-Giuffrida.  His  native  city,  Catania,  honored  the 


THE  UNIVERSITIES  OF  SICILY  203 

anniversary  of  his  death  in  July,  1920,  and  the  parlia- 
ment of  Rome,  where  he  represented  his  "College" 
for  so  many  years,  devoted  a  special  meeting  to  eulogiz- 
ing his  life,  his  work  and  his  intelligence,  bestowed 
entirely  upon  his  country  and  his  ideals.  Catania,  which 
was  the  constant  object  of  his  socialistic  reforms,  is 
today  a  beautiful  modern  city  of  150,000  inhabitants, 
perhaps  one  of  the  most  progressive  cities  of  Italy,  and 
certainly  the  most  advanced  in  every  modern  improve- 
ment in  industry,  trade  and  commerce.  Well  favored 
by  a  good  seaport,  it  ranks  second,  after  Genoa,  in 
activity  and  importance. 

The  splendid  contribution  of  the  Sicilians  to  the  war 
will  remain  in  the  history  of  Italy  as  one  of  the  brilliant 
episodes,  indicative  of  the  unification  of  the  Italian 
people  from  the  Alps  to  the  extreme  southern  point  of 
the  island,  Capo  Passero,  which  is  the  best  guarantee  of 
the  national  solidity  of  the  new  country. 

PALERMO 

Palermo  did  not,  like  Catania,  nurse  in  its  bosom 
a  De  Felice  Giuffrida.  The  capital  of  Sicily  with  its 
250,000  inhabitants  has  changed  but  little,  for,  like  a 
coquettish,  beautiful  woman  quite  satisfied  with  her 
beauty,  the  town  did  not  think  it  necessary  to  add 
anything  to  enhance  its  attractiveness.  Nature  has 
been  so  generous  in  its  favors  that  Palermo  will  always 
be  a  fascinating  place,  without  any  touch  of  up-to-date 
civilization:  the  famous  cathedral,  the  famous  theater, 
the  famous  Villa  Reale,  the  famous  Monte  Pellegrino 
are  quite  enough  to  satisfy  the  pride  of  any  city  in  the 
world.  Besides,  it  has  its  glorious  past  history,  and  the 


204  MODERN  ITALIAN  SURGERY 

still  more  glorious  history  of  modern  Italy,  which  is, 
perhaps,  the  most  glorious  of  all. 

On  May  27,  i860,  the  red-shirted  immortals, 
"The  One  Thousand  of  Garibaldi,"  captured  the  city. 
When  the  citizens,  frantic  with  joy,  rushed  to  the  belfry 
to  sound  the  tocsin,  they  found  that  the  Bourbon  police 
had  removed  the  clappers,  but  undaunted,  the  infur- 
iated crowd,  with  hammers,  terrified  the  mercenary 
soldiers  of  the  Bourbons.  Eight  hundred  red-shirted 
volunteers  of  Garibaldi,  followed  by  a  horde  of  4,000 
youths  of  Sicily,  poorly  armed,  wrested  the  city  from 
20,000  regular  soldiers,  well  armed  and  fortified  in  the 
most  strategic  points  of  the  city.  Palermo  was  free,  and 
from  that  day,  the  whole  kingdom  of  the  Bourbons  was 
doomed. 

All  this  and  the  enchantment  of  the  perfect  climate, 
the  luxurious  tropical  vegetation  which  made  the 
"Golfo  degli  Aranci"  and  "La  Conca  d'Oro"  a  famous 
attraction  for  tourists,  for  health  seekers  and  pleasure 
lovers,  did  not  seem  to  be  inducive  to  meditation  and 
study.  Yet  the  city  is  today  the  possessor  of  a  very 
important  atheneum,  is  the  center  of  an  advanced 
educational  system  not  inferior  to  the  best  university 
of  Italy,  a  remarkable  fact  considering  its  recent 
foundation. 

The  opposition  of  the  two  old  Universities  of  Catania 
and  Messina  frustrated  the  effort  of  the  citizens  of 
Palermo  in  obtaining  a  Government  grant  and  support 
to  a  university.  So  it  was  only  in  1771  that  a  Royal 
Academy  was  inaugurated,  and,  in  1805,  a  university 
granted,  which  began  to  rise  in  importance  until  i860, 
the  year  of  the  annexation  of  Sicily  to  the  new  king- 


THE  UNIVERSITIES  OF  SICILY  205 

dom  of  Italy.  Palermo's  university  has  today  a  matric- 
ulation of  about  1,500  students  in  its  five  faculties,  and 
its  surgical  clinic  has  achieved  more  than  a  national 
reputation. 

The  surgical  clinic,  previously  directed  by  Iginio 
Tansini,  at  present  professor  at  the  University  of  Pavia, 
is  ably  directed  by  Prof.  Ernesto  Tricomi,  a  pupil 
of  Professor  D'Antona  of  Naples.  Professor  Tricomi, 
apart  from  his  reputation  as  a  learned  pathologist,  is 
considered  an  able  and  brilliant  operator,  especially  in 
abdominal  surgery.  His  "Contributions  to  Gastro- 
Entero- Anastomosis"  (1899);  a  total  extirpation  of 
the  stomach  accomplished  in  the  same  year  following 
a  special  method  of  gastrostenoplastic  in  cases  of 
idiopathic  gastrectasia  (1895);  n*s  interesting  experi- 
ments on  hemostasis  of  the  liver,  with  gauze  packing 
and  omentopexy,  followed  by  a  partial  hepatectomy 
(1893),  and  a  resection  of  the  left  lobe  of  the  liver 
( 1 894) ;  his  rapid  method  of  treatment  of  echinococcus 
cyst,  with  total  extirpation  of  the  echinococcus  liver 
(2  cases  in  1899);  his  surgery  of  the  pancreas  (1898); 
and  important  contributions  covering  statistics  of 
seventeen  operations  for  splenectomy :  seven  for  malarial 
hypertrophy,  five  for  ectopy,  three  for  simple  hyper- 
trophy, one  for  leukemic  hypertrophy,  and  one  for  an 
echinococcus  cyst  (1898) — all  are  emphatically  worthy 
of  special  mention. 

Tricomi  also  described  a  new  method  for  the  treat- 
ment of  crural  hernia,  consisting  in  the  use  of  one  stitch, 
U-form,  which  should  include  the  inguinal  ligament  of 
Cooper,  the  sheaths  of  the  vessels,  the  pectineal  and 
Gimbernat's  ligaments  (1891);  and  in  1 896  he  proposed 


206  MODERN  ITALIAN  SURGERY 

a  modification  of  nephropexy,  while  in  the  same  year  he 
published  3  cases  of  Basedow's  disease,  treated  surgi- 
cally with  success. 

At  the  University  of  Palermo,  there  is  also  an  institute 
of  operative  medicine,  independent  of  the  surgical 
clinic,  under  Prof.  Gaetano  Parlavecchio,  pupil  of 
Professors  D'Antona  of  Naples,  and  Durante  of  Rome. 
Parlavecchio,  like  Tricomi,  has  to  his  credit  a  large 
contribution  to  surgical  literature,  including  abdominal 
cases.  Among  his  original  writings  there  is  a  publication, 
worthy  of  note  as  preceding  by  a  great  many  years 
a  similar  one  on  the  same  subject  in  Annals  of 
Surgery1  ("Transthoracic  Laparatomy  ") — "Contributo 
alia  Chirurgia  del  Diaframma,  Operazioni  per  Suture 
di  Ferite  Diaframmatiche  coi  Metodi  di  Postempski  e 
Rydigier  Modificati.  "2 

Another  is,  "Le  Nuove  Conquiste  della  Chirurgia 
Renale"3  in  which  Parlavecchio  refers  to  a  case  of 
incision  of  the  kidney  to  the  papilla,  decortication  and 
packing  with  omentum,  and  ten  days  after,  ligature  of 
the  vessels  of  the  hilus,  followed  after  eight  days  by 
extirpation  of  the  other  kidney  (omental  intraperirenal 
telangiostomosis).  Several  other  publications,  "On 
Rhinoplasty;"  "Splenotomy;"  "A  Case  of  Wounds 
of  the  Heart  Successfully  Treated  with  Immediate 
Suture;"  "A  New  Method  in  the  Treatment  of  Crural 
Hernia,"  and  many  other  valuable  contributions  place 
him  among  the  leading  surgeons  of  Italy. 

Several  young  adjunct  professors,  especially  devoted 

1  August,  1919,  ixx,  No.  2. 
zRiforma  med.,  1893,  ii,  146. 
3  Tip.  Brangi.  Palermo,  1906. 


THE  UNIVERSITIES  OF  SICILY  207 

to  surgical  pathology,  attend  to  the  instruction  of  the 
students,  among  them,  Eugenio  Arcoleo,  Abele  Ajello, 
Vincenzo  Baviera,  Clemente  Calzavara,  Salvatore 
Deliberti,  Carlo  Pantaleoni,  Giuseppe  Piazza  and  other 
rising  surgeons. 

CATANIA 

The  rise  of  the  University  of  Palermo  was  naturally 
detrimental  to  that  of  Catania,  the  oldest  university  of 
the  island.  Founded  in  1444  by  Alfonso  of  Aragon — 
largely  endowed,  it  reached  a  climax  of  prosperity, 
when,  as  the  only  atheneum  of  the  island,  it  was 
frequented  by  more  than  2,000  students. 

The  terrible  earthquake  of  1693  having  destroyed  the 
large  palace,  built  in  1684,  a  new  building  was  erected 
after  many  years  and  completed  only  in  18 18,  with  many 
laboratories  equipped  with  all  modern  requirements. 

The  surgical  clinic  was  under  Prof.  Gesualdo  Clementi, 
a  surgeon  and  clinician  of  established  reputation. 
Following  the  tendency  of  many  modern  surgeons,  he 
devoted  his  time  more  to  abdominal  surgery  than  to  any 
other  branch,  contributing  by  means  of  operations  and 
statistics  to  the  literature  on  the  various  abdominal 
affections.  He  was  one  of  the  pioneers  in  suggesting 
early  surgical  intervention  in  abdominal  traumas,  and 
at  the  Congress  of  Italian  Surgery  in  189 1,  he  presented 
65  cases  of  penetrating  abdominal  wounds  successfully 
cured  by  early  laparotomy.  At  the  same  Congress  he 
also  contributed  an  article  on  hemostasis  in  the  resection 
of  the  liver  with  the  immediate  ligature  of  the  injured 
vessels.  He  was  considered  one  of  the  most  daring  and 
able  modern  surgeons  in  Italy. 


208  MODERN  ITALIAN  SURGERY 

Occupying  the  chair  of  special  surgical  pathology  at 
present  is  Prof.  Giuseppe  Muscatello,  a  reputable  pathol- 
ogist, who  published  some  interesting  studies  on  spina 
bifida,  following  von  Recklinghausen's  classical  work, 
giving  a  classification  based  on  an  anatoraicopathologic 
conception  recognized  and  accepted  by  every  scientist. 
His  studies  on  the  lymphatics  of  the  diaphragm  are  very 
original,  as  are  also  his  contributions  to  the  suture  of 
the  arteries  and  his  experiments  on  empyema  from 
staphylococcus. 

Before  coming  to  Catania,  Muscatello  was  pathologist 
at  the  University  of  Pavia,  where  he  had  distinguished 
himself  both  as  a  clinician  and  an  operator,  publishing 
the  history  of  a  case  of  pneumonic  abscess  and  another 
of  the  spleen;  likewise  a  work  on  the  radical  cure  of 
exstrophy  of  the  bladder  (1904),  with  a  modification  of 
the  operation  of  Maydl  (ureterotrigonosigmoidostomy) ; 
another  on  the  tubercular  multiple  stenosis  of  the 
intestine  of  children,  and  the  intestinal  obstructions 
from  ascarides  (1905). 

Special  adjunct  instructors  at  the  University  of 
Catania  in  special  surgical  pathology  are:  Michele 
Guzzardi,  Annibale  Costa,  Vincenzo  Tomaselli,  Nunzio 
di  Stefano,  Giovanni  Zurria,  Umberto  Benedetto;  and 
at  the  surgical  clinic:  Gaetano  Caponetto,  Ottaviano 
Giuliano,  Santi  Rindone  and  Carmelo  Ferlito. 

MESSINA 

Messina  was  reduced  to  a  heap  of  ruins  on  December 
28,  1908,  by  a  fearful  earthquake  followed  by  a  tidal 
wave.  One  hundred  thousand  people,  of  the  150,000 
(which  was  the  total  population  of  the  city  at  that  time) 


THE  UNIVERSITIES  OF  SICILY  209 

perished  in  the  terrible  catastrophe  and  the  university- 
was  also  destroyed,  with  great  loss  of  life  among  the 
professors,  and  with  the  irreparable  loss  of  all  the  scien- 
tific collections,  libraries  and  documents.  The  surgical 
faculty  lost  Prof.  Gaspare  D'Urso,  a  pupil  of  Professor 
D'Antona,  who  was  holding  with  honor  the  chair  of 
clinical  surgery  and  operative  medicine.  Professsor 
D'Urso,  also  an  excellent  pathologist,  left  a  large  col- 
lection of  scientific  publications,  including  a  valuable 
volume  on  "Bone  Diseases',  (1893);  a  study  on  bilious 
exudation  into  the  peritoneum,  with  demonstrations  on 
its  innocuity;  experimental  researches  on  the  effect  of 
anastomosis  of  the  deferent  and  ureter;  and  articles  on 
pyonephrosis,  on  the  resistance  of  venous  blood-vessels 
against  the  invasion  of  sarcoma,  on  primary  endothe- 
lioma of  the  liver,  ichthyosis  of  the  uterus,  tumor  of  the 
ovaries,  malignant  tumors  of  the  bones — especially 
endothelioma,  the  last  being  an  original,  complete  work 
on  the  subject.  Of  great  merit  also  are  his  statistical 
publications  on  the  work  of  the  surgical  clinic  of 
Messina.  Unfortunately,  with  him  perished  his  distin- 
guished assistant,  Prof.  Giuseppe  Betagh,  demonstrator 
of  surgical  pathology. 

The  school  of  medicine  of  Messina  has  been  reor- 
ganized and  was  inaugurated  again  in  191 8  with  Prof. 
Stefano  Puglisi  Allegra  at  the  surgical  clinic  and  Angelo 
Isaia  at  the  head  of  the  department  of  special  surgical 
pathology.  They  expect  in  time  to  rebuild  the  labora- 
tories and  the  hospitals. 


M 


Chapter  XXIV 
THE  UNIVERSITIES  OF  SARDINIA 

THE  island  of  Sardinia,  the  second  in  size  of  the 
Mediterranean  islands,  the  first  being  Sicily, 
has  an  area  of  about  9,300  square  miles, 
with  a  population  of  nearly  870,000  souls, 
while  the  State  of  Vermont,  with  an  area  of  about 
9,700  square  miles,  has  a  population  of  less  than 
360,000  inhabitants.  But  Vermont  is  in  the  United 
States,  while  Sardinia  is  a  neglected  island  in  the 
Mediterranean  Sea,  cut  off  from  the  continent  by  insuffi- 
cient means  of  communication.  This  circumstance 
unfortunately  has  retarded  the  development  of  the 
agricultural  and  mineral  resources  that  could  bring 
wealth  and  comfort  to  the  people,  otherwise  naturally 
intelligent  and  intensely  laborious. 

As  it  is,  on  account  of  the  difficulty  of  communica- 
tion, the  cities  of  the  coast  are  the  principal  centers  of 
population.  Cagliari  at  the  extreme  southeast,  with  over 
50,000  inhabitants,  and  Sassari  at  the  extreme  north- 
west with  about  35,000  inhabitants  are  the  most 
important.  Both  are  provided  with  universities.  The 
first  was  founded  in  1626,  the  second  in  161 7;  both  now 
conform  to  the  uniform  standard  of  the  other  universi- 
ties of  the  kingdom. 

THE  UNIVERSITY  OF  CAGLIARI 

The  surgical  clinic  of  Cagliari  is  under  the  direction 
of  Prof.  Roberto  Binaghi,  pupil  of  the  late  Angelo  Roth. 


THE  UNIVERSITIES  OF  SARDINIA  211 

His  experimental  researches  upon  the  pathogenesis  of 
intestinal  invagination  (1902),  epigastric  hernia,  and 
his  clinical  studies  on  pyelotomy  for  giant  calculus 
of  the  little  pelvis,  with  pyeloplastic  and  posterior 
permanent  catheterism  of  the  ureter,  are  well  known 
works. 

The  institute  of  surgical  pathology  is  under  Prof. 
Gaetano  Fichera,  a  pupil  of  Professor  Durante  of  Rome. 
Professor  Fichera  devotes  his  time  especially  to  the 
study  of  tumors,  and  has  founded  a  review  in  which 
he  collects  all  the  scientific  studies  and  publications 
upon  tumors  in  Italy. 

Professor  Binaghi  is  well  supported  by  able  assistants 
in  the  persons  of  Francesco  Potzu,  Antonio  de  Cortes, 
and  Angelo  Garau ;  while  general  pathology  is  under  the 
superintendence  of  Prof.  Aldo  Perroncito,  son  of  the 
famous  pathologist  and  bacteriologist  of  the  University 
of  Turin. 

UNIVERSITY    OF    SASSARI 

The  University  of  Sassari  had  for  many  years  a  very 
able  practical  surgeon  as  the  incumbent  of  the  surgical 
chair  in  Prof.  Angelo  Roth,  recently  deceased. 

Professor  Roth  left  some  valuable  publications  on 
prostatic  gland  surgery,  and  the  Folia  Urologica  of 
Leipzig  (1907)  published  his  315  observations  on  supra- 
pubic cystotomy,  an  operation  which  he  was  the  first 
to  practice  in  the  treatment  of  urethral  fistula  (1886- 
1889).  Several  years  later,  Pousson  (1894)  claimed 
priority  for  the  use  of  this  treatment  which  was  original 
with  Roth. 

The  chair  of  surgery  after  the  death  of  Angelo  Roth 


212  MODERN  ITALIAN  SURGERY 

was  temporarly  occupied  by  Giovanni  Andrea  Pietri  in 
the  departments  of  clinical  surgery  and  surgical  pathol- 
ogy, and  by  Vincenzo  Dettori  in  operative  medicine, 
having  for  his  assistant,  Prof.  Vincenzo  Giordano, 
who  has  published  some  valuable  treatises  on  thoracic 
surgery. 


Chapter  XXV 
FREE  UNIVERSITIES 

OF  the  three  free  universities,  Perugia,  Camerino 
and  Ferrara,  the  only  one  which  is  complete 
is  the  first.  Perugia,  a  small  city  of  about 
25,000  inhabitants,  half-way  between  Flor- 
ence and  Rome,  is  well  known  to  the  world  of  artists 
and  to  pleasure  seeking  tourists  for  its  position,  its 
historical  importance  as  the  capital  of  beautiful  Umbria, 
and  for  its  precious  collection  of  artistic  treasures.  Its 
situation  is  splendid  and  its  accommodations  in  com- 
fortable hotels  and  hospitable  houses  are  unparalleled. 
In  a  book  published  twenty  years  ago  by  Margaret 
Symonds  and  Lina  Duff  Gordon,  a  splendid  description 
of  the  origin  of  the  city,  its  vicissitudes  and  its  present 
condition  is  given  so  accurately  that  any  addition  would 
be  futile. 

The  university,  five  hundred  years  old,  has  been 
reorganized  since  1886.  Shortly  after,  a  worthy  pupil 
of  the  surgical  school  of  the  University  of  Turin, 
Professor  De  Paoli,  was  elected  to  the  chair  of  clinical 
surgery  and  surgical  pathology,  and  held  it  with  great 
honor  until  191 3.  During  that  long  period,  he  published: 
"Researches  on  Tuberculosis  of  the  Salivary  Glands'' 
(1894);  "On  Percussion  of  the  Skull  in  Traumas  and 
Endocranial  Diseases"  (1897) ;  "Traumatic  Detachment 
of  the  Epiphysis"  (1903);  "Researches  on  the  Efficacy 
of  Injection  of  Nucleinate  of  Soda  to  Prevent  Operatory 
Peritoneal  Infections"  (1910);  "Researches  on  Biliary 

213 


214  MODERN  ITALIAN  SURGERY 

Calculus"  (1921);  "Contribution  to  the  Histological 
Studies  of  Renal  Angiosarcoma,  of  the  Tumor  of  the 
Suprarenal  Capsule."  AH  these  contributions  are  well 
known  in  the  scientific  world. 

At  present,  several  scholars  from  the  school  at 
Perugia  direct  the  clinics  of  the  important  hospitals  in 
several  cities  in  Italy — Professor  Santarnecchi  of 
Umbertide,  Professor  Mattoli  of  Chieti,  Professor 
Gianantoni  of  Fabriano,  Professor  Arcangeli  of  Cavar- 
zere,  Professor  Rubegni  of  Gualdo-Sabino,  and  Professor 
Bracci  of  Terni. 

Professor  De  Paoli  after  his  retirement  served  with 
distinction  during  the  war  as  colonel  in  the  Reserve 
Corps. 

The  present  director  of  the  surgical  clinic  of  Perugia 
is  Prof.  Carlo  Righetti,  pupil  of  Professor  Burci  of 
Florence.  He  has  to  his  credit  some  very  important 
publications  on  cranial  surgery,  on  the  pathogenesis  of 
hemorrhages  in  hydronephrosis,  and  on  the  lesions  of 
the  thoracic  duct  in  the  neck.  Professor  Righetti  served 
with  distinction  during  the  war. 

At  the  University  of  Camerino,  Prof.  Giovanni 
Razzaboni,  an  able  pathologist,  is  director  of  the  surgical 
clinic,  where  he  has  already  published  some  valuable 
works  on  suppurative  phlogosis  of  the  lung  and  pleura; 
on  the  slow  healing  of  thoracic  empyema  after 
resection  of  the  ribs;  on  the  evolution  of  lymphatic 
glands  in  fractures;  on  sarcoids  and  their  blastomycetic 
origin;  and  on  craniocerebral  topography. 

The  University  of  Ferrara  lacks  at  present  the  com- 
plete course,  and  there  is  no  incumbent  in  the  surgical 
department. 


Chapter  XXVI 
SURGICAL  LITERATURE 

THE  medical  press  in  Italy  is  well  repre- 
sented and  may  be  considered  equal  to  the 
scientific  progress  of  the  time. 

The  most  important  review  is  La  Clinica 
cbirurgica,  founded  in  1893  by  Professors  Bottini  and 
Tansini,  originally  directed  by  Professor  Ceccherelli  of 
Parma,  and  at  present  by  Prof.  Roberto  Alessandri  of 
Rome.  It  contains,  in  every  issue,  many  original  articles 
and  a  special  section,  called  "Subjects  of  the  Day," 
in  which  the  director  mentions,  illustrates  and  discusses 
the  most  vital  surgical  questions  treated  by  the  domestic 
or  foreign  press.  This  is  followed  by  a  synthetic  review 
of  some  pathological  or  clinical  thesis  and  a  biblio- 
graphic summary,  with  brief  comments  on  all  the  home 
and  foreign  publications  on  surgery,  besides  the  usual 
criticism  of  all  the  publications  on  surgery  by  the 
medical  academies  of  Italy.  It  is  a  monthly  review  which 
contains  the  greater  part  of  the  history  of  Italian 
surgery,  and  during  the  war  was  the  echo  of  all  the  work 
and   writings   upon   war   surgery   worth   mentioning. 

The  Policlinico  is  a  periodical  founded  by  Professors 
Baccelli  and  Durante  in  1894,  which  deals,  in  three 
separate  parts,  with  medicine,  surgery  and  everyday 
practice,  with  original  articles  by  members  of  the  Italian 
Medical  Society  and  some  from  practicing  surgeons. 

The  other  reviews  are:  La  Rijorma  medica;  Gazzetta 
degli  ospedali  e  delle  clinicbe;  Gazzetta  Internazionale 

215 


216  MODERN  ITALIAN  SURGERY 

di  medicina,  chirurgia  e  igiene;  La  Rijorma  veneta  di 
scienze  mediche;  Lo  Sperimentale  (a  journal  of  medical 
sciences,  founded  by  Bufalini  in  1848),  actually  the 
organ  of  the  Academy  of  Medicine  of  Florence;  II 
Morgagni  (founded  in  Naples  by  Tommasi)  divided 
in  three  parts — an  archive  of  original  collections,  a 
bulletin  of  clinical  data  and  a  review.  Pensiero  medico 
and  Rivista  ospedaliera  of  Rome,  have  also  important 
notes  on  surgery. 

Although  not  exactly  in  the  actual  line  of  surgery, 
mention  must  be  made  of  the  Archivio  di  ostetricia  e 
ginecologia,  La  Rassegna  d' ostetricia  e  ginecologia,  Annali 
di  ostetricia  e  ginecologia,  La  Ginecologia,  and  Folia 
ginecologica. 

Every  university  has  its  academy  of  medicine  with 
the  usual  bulletin  or  newspaper,  containing  sometimes 
extremely  important  communications;  as,  for  instance, 
the  academies  of  Turin,  Rome,  Bologna,  Genoa,  etc. 
Naval  and  military  surgery  has  two  reviews  which  have 
been  very  important  during  the  war. 

The  Italian  Surgical  Society  is  an  old  and  solid 
institution,  which  holds  congresses  every  year,  dis- 
cussing important  subjects  relating  to  clinical  surgery 
and  pathology.  Last  year  the  congress  convened  in 
Trieste. 

It  was  mentioned  in  the  chapter  on  Cagliari  that 
Professor  Fichera,  director  of  the  surgical  clinic,  pub- 
lishes a  review  on  tumors  in  which  he  gathers  all 
contributions,  laboratory  and  clinical  observations 
which  illustrate  the  pathogenesis  and  the  pathological 
anatomy  of  malignant  blastomata,  and  the  most  modern 
treatment. 


SURGICAL  LITERATURE  217 

Among  the  periodicals  of  general  character  is  the 
Archivio  per  le  scienze  mediche,  founded  by  the  lamented 
Professor  Bizzozzero,  which  continues  its  publications 
on  anatomy,  physiology,  pathological  anatomy  and 
clinical  data  under  Profs.  Romeo  Fusari  and  Benedetto 
Morpurgo  of  the  University  of  Turin. 

Italy  does  not  lack  in  valuable  treatises,  among  which 
well  worthy  of  note  are  those  by:  Luigi  Luciani  on 
physiology;  Guglielmo  Romiti,  Giulio  Chiarugi  and 
Romeo  Fusari,  each  with  a  book  on  descriptive  human 
anatomy;  Alessandro  Lustig  and  Gino  Galeotti,  each 
with  a  publication  on  general  pathology;  Guido  Banti, 
on  pathologic  anatomy ;  Francesco  Durante,  on  clinical 
surgery  and  pathology,  with  another  on  operative 
medicine ;  Domenico  Taddei  on  surgical  symptomatology ; 
Davide  Giordano,  on  operative  medicine,  and  many 
other  treatises  on  different  subjects  relating  to  surgery, 
pathology  and  operative  medicine.  Many  serve  as 
textbooks  for  schools  and  some  have  been  translated. 

Unfortunately,  most  of  the  treatises  of  the  past  have 
been  hidden  away  in  scattered  localities,  remaining 
confined  to  the  small  center  of  a  university,  known 
only  to  the  limited  number  of  students  or  practitioners 
of  that  special  region.  For  instance,  the  writer  of  these 
pages,  many  years  ago,  while  in  London  attending 
the  clinic  of  Sir  Henry  Thompson,  admired  his  rapid 
dilatation  of  urethral  strictures.  He  was  told  with  a 
complimentary  smile,  that  the  method  was  that  of 
Antonino  Toscano  of  Catania.  On  inquiry,  he  found  out, 
not  without  difficulty,  that  Toscano  had  written  a 
treatise  on  the  subject,  which  was  almost  unknown 
in  his  own  country. 


218  MODERN  ITALIAN  SURGERY 

Few  indeed  are  familiar  with  the  notable  writings 
of  G.  Fiorani,  on  amputations  with  elastic  ligature, 
and  few  would  have  known  the  long  and  accurate 
experiments  of  Giuliano  Vanghetti,  the  modest  but 
great  practitioner  of  the  little  town  of  Empoli,  if 
Professor  Ceci,  first,  and  others  following  him,  had  not 
applied  his  original  discovery  to  practical  use. 

Scientific  Italy  is  waking  up  to  the  realization  that 
its  work  cannot  always  be  stolen  with  impunity  for  the 
benefit  of  other  nations,  and  that  it  is  important  for  her 
dignity  that  her  standing  among  the  nations  working  for 
modern  progress  in  surgery  should  not  be  ignored. 

It  is  to  be  hoped  that  the  scholarships  and  the 
exchange  professorships  of  universities,  as  well  as  the 
already  planned  translation  of  the  most  important 
works  of  science,  will  soon  reveal  what  modern  Italy 
is,  and  what  scientific  intellectual  Italy  can  do. 

Handbook  of  Italian  Operative  Surgery 
By  Proj.  Davide  Giordano,  Head  Surgeon 

VENICE 

Dr.  Davide  Giordano,  chief  of  the  Civic  Hospital  of 
Venice,  published  in  191 1  a  large  volume  entitled 
"Compendio  di  Chirurgia  Operatoria  Italiana"  which 
might  well  be  called  the  history  of  Italian  surgery.  The 
publication  is  a  large  and  exhaustive  compilation  which 
gives  to  the  reader  a  good  idea  of  the  enormous  work 
done  by  Italians  in  the  field  of  surgery.  The  book  was 
reviewed  by  Prof.  Giacomo  Filippo  Novaro,  his  old 
master  and  teacher,  recently  retired  from  the  University 


SURGICAL  LITERATURE  219 

of  Genoa,  and  published  by  "Unione  Tipografico- 
Editrice  Torinese." 

It  is  divided  into  two  parts :  The  generic  section  and 
the  surgery  of  the  different  regions.  The  first  part  deals 
with  Anesthesia;  Hemostasis;  Aneurysms;  Ligatures; 
Preventive  Hemostasis;  Transfusion;  Endo venous  In- 
jections; Medication;  Sutures;  Organotherapy;  Ex- 
amples of  Dressing  in  Special  Infections;  Tetanus; 
Carbuncle;  Actinomycosis;  Erysipelas;  Tuberculosis; 
Lupus. 

In  the  section  on  the  surgery  of  the  different  regions 
Giordano  embraces  the  whole  system  from  head  to  foot, 
patiently  gathering  all  the  work  done  by  Italian  sur- 
geons in  the  past  and  the  excellent  work  done  recently, 
pointing  out  the  many  original  discoveries  which  have 
been  shamelessly  appropriated  by  unscrupulous 
foreigners. 

In  his  history  of  cranial  surgery  he  mentions  Andrea 
della  Croce,  who  described  (1549)  the  armamentarium 
for  the  surgery  of  the  head ;  Paolo  Veronese,  who  wrote 
"De  Vulnerum  Capitis  Curatione  Libellus"  (Venetiis, 
1549);  and  Giovanni  Passero  Bergamasco  (De  Causis 
Mortis  in  Vulneribus  Capitis  .  .  .  Et  Recta  Eorum 
Curatione  .  .  .  De  Perforatione  Et  Abrasionibus  in 
Cranii  Lesionibus  Non  Satis  Apparentibus,  1590),  who 
then  proposed  trephining  in  cases  of  brain  hemorrhage 
in  which  Fabricius  ab  Aquapendente  insisted  upon  open- 
ing the  dura.  The  same  advice  is  given  by  Leone  G. 
B.  Carcano  (a  pupil  of  Falloppio)  who  well  describes 
the  symptoms  of  cranial  contusions,  deep  hemorrhage 
without  cranial  lesions,  accumulation  of  pus,  in  which 
he  did  not  hesitate  to  intervene. 


220  MODERN  ITALIAN  SURGERY 

Giordano  also  mentions,  in  early  cranial  surgery,  Cesare 
Magati,  Pietro  Marchetti  and  Marco  Aurelio  Severino, 
who  set  the  rule  of  trephining  in  syphilitic  cephalalgia, 
with  the  urgent  opening  of  the  skull  in  any  case  of 
epilepsy. 

Opposed  to  such  a  heroic  proceeding  were  Anselmo 
da  Genova,  in  the  twelfth  century,  and  Nicolo'  Cappel- 
Ietti  da  Lucca  in  the  eighteenth,  although  the  operation 
was  supported  in  Florence  by  Benevoli  and  Nannoni, 
in  Milan  by  Molinelli,  in  Turin  by  Bertrandi. 

Giovanni  Battista  Cortesi  of  Messina  comments 
upon  Berengario's  trephining  of  the  frontal  sutures,  and 
Rouhald  of  Turin  upon  the  dura,  which  was  practiced 
also  by  Riberi  of  the  same  city. 

Vacca-Berlinghieri  of  Pisa,  following  the  example  of 
Giuntini  and  Angiolo  Nannoni,  used  trephining  in  sup- 
purative meningitis,  and  made  valuable  studies  on 
crossed  hemiplegia,  warning  against  the  theory 
advanced  by  Cassio  Introsofista  and  approved  by 
Valsalva. 

Ranzi  and  Rizzoli  gave  capital  advice  on  interven- 
tion in  cases  of  intracranial  effusions,  naming  the  tem- 
poral region  as  the  selective  place  for  trephining. 

In  Siena,  Zanobi  Pecchioli  trephined  for  a  malignant 
tumor,  Palasciano  in  Naples,  successfully  removed  an 
echinococcus  cyst  from  the  encephalon;  in  Bologna, 
Rizzoli,  with  a  trephine  larger  than  ever  used  before, 
removed  an  old  exostosis  from  trauma  which  was 
causing  epilepsy.  More  audacious,  Vanzetti  removed  a 
large  tumor  which  had  displaced  the  median  lobe  of  the 
brain  ("Observations  d'un  kyste  osseux  situe  au  cote 
droit  de  la  tete,  qui  avait  detruit  la  base  du  crane  sans 


SURGICAL  LITERATURE  221 

derangement  des  fonctions  du  cerveau,"  Kharkoff- 
Paris,  1845),  while  Ferdinando  Zannettiwas  publishing 
his  large  and  valuable  work,  "La  trapanazione  del 
cranio  dell'uomo  riconfermata  nelle  practica  delPalta 
chirurgia  operatoria."1  The  great  anatomist,  Prof. 
Carlo  Giacomini  of  the  University  of  Turin,  published 
his  very  original  work2  inspired  especially  by  the 
experiences  of  Broca  and  Ferrier,  trying  to  give  a  correct 
connection  between  the  cranium  and  encephalon,  the 
rolandic  zone  and  the  central  part  of  the  cerebral 
hemisphere,  which  the  surgical  knife  could  reach  with 
safety.  This  careful  description  of  Giacomini  has  been 
a  great  help  to  the  surgeons. 

Following  that  line,  Prof.  Antonino  D'Antona  of 
Naples,  published  "La  Nuova  Chirurgia  del  Sistema 
Nervoso  Centralc,"3  giving  a  graphic  account  almost 
with  mathematical  precison. 

Fabrizio  Padula,  likewise  from  Naples,  in  his  "Chir- 
urgia Cranica,"  takes  up  the  subject  of  the  rolandic 
line,  which  has  been  discussed  with  mutual  advantage 
also  by  Prof.  Giovanni  Pascale,  the  present  director  of 
the  surgical  clinic  of  Naples,  and  by  Prof.  Michele  Titone 
of  the  University  of  Palermo,  since  transferred  to  Pa  via. 

Another  distinguished  surgeon  of  Padua,  Prof. 
Rodolfo  Penzo,  assistant  of  Bassini,  describes  a  method 
somewhat  different  from  the  one  of  D'Antona,  and 
which  is  highly  ingenious.4 

Cranial  surgery   in   Italy   has   numerous   followers, 

'Prof.  Ferdinando  Zannetti,  Prato,  1878. 
*Topografia  Delia  Scissura  di  Rolando,  Torino,  1878. 
'Napoli,  1893. 

*  Proposta  di  un  nuovo  metodo  di  ricerca  del  solco  di  Rolando.  Rijorma 
Med.,  1897,  15. 


222  MODERN  ITALIAN  SURGERY 

but  the  list  is  too  long  to  enumerate  in  book  form,  or  in 
reviews.  Suffice  it  to  mention  the  late  Emilio  Scafi.1 
Scafi  suggests,  in  his  publication,  an  original  method 
for  obtaining  a  large  flap  of  bone,  with  two  operations : 
one,  for  the  purpose  of  resecting  the  bone,  giving  time 
for  the  wound  of  the  scalp  to  heal;  the  second,  for  revert- 
ing the  large  flap,  which  following  the  operation,  is 
sewed  into  place  without  loss  of  bone  substance. 

Also  the  following  contributions: 

Alessandro  Codevilla:  "Dei  mezzi  di  riparazione  delle 
scontinuita*  craniche.  "2 

Ercole  Sacchi:  "del  modo  di  riparare  Ie  perdite  di 
sostanza  del  cranio"  and  " Plastiche  della  dura  madre;"* 
also  "Contributo  alia  tecnica  delle  plastiche  del  cranio 
cd  alio  studio  dei  Iobi  prefrontali."4 

Pietro  Ferrari:  "Obliterazione  sperimentale  dei  seni 
della  duramadre."5 

G.  F.  Novaro:  "Sulla  chirurgia  cerebrale."6 

A.  Murri:  "La  craniotomia  esplorativa  e  la  diag- 
nosi  delF  ascesso  cerebrale  cronico."7 

D.  Giordano:  "trapanazione  del  cranio  in  seguito  a 
ferite  della  arteria  meningea  media."8 

A.  Ceccherelli:  "L'apertura  delle  cavita*  nei  casi  di 
raccolte  purulente."9 

1  Tecnica    ed    indicazioni    delle    reserzioni    craniche   (Ext.  Bull.,  Societa 
Lancisiana). 

2  Arch,  di  Ortop.,  vm,  No.  6. 
3RiJorma  Med.,  August,  1893. 
*Riforma  Med.,  February,  1894. 

5  Arch,  per  le  Sc.  Med.,  xn,  No.  19. 

8  Bull.  d.  Sc.  Med.,  Bologna,  7  s„  11,  1891. 

7 Policlin.,  11,  January  15,  1895. 

*Gazz.  med.  di  Torino,  1893,  xliii. 

9Med.  contemp.,  vi,  vn,  1885. 


SURGICAL  LITERATURE  223 

A.  Nannotti:  "Primo  contributo  sperimentalle  sulla 
cura  chirurgica  delle  meningiti."1 

G.  Gradenigo:  "Sulla  tecnica  operativa  dell'  ascesso 
cerebrate  ottico."2 

Too  much  space  would  be  required  to  give  here  the 
names  of  all  the  surgeons  of  Italy  who  have  written 
upon  cranial  surgery.  Something,  however,  must  be 
said  about  the  literature  on  the  pituitary  gland,  and 
the  work  done  in  Italy  on  that  subject,  as  for  instance: 

Ercole  Sacchi:  "L' acromegalia."3 

G.  Vassale  ed  Ercole  Sacchi:  "Sulla  distruzione 
della  ghiandola  pituitaria."4 

Tamburini:  "Contributo  alia  patogenesi  delP  acro- 
megalia/'5 

Lodovico  Isnardi:  "  Microcefalia  e  craniectomia."6 

Carlo  Giacomini:  "I  cervelli  dei  microcefali."7 

D.  Giordano:  "La  craniectomia  nei  microcefali,  Ri- 
vista  Critica."8 

E.  Morselli:  "La  cura  chirurgica  dell'  idiotismo."9 
Italian  surgery   has  many  remarkable  publications 

upon  trigeminal  neuralgia,  among  them  those  by  Baroni, 
Fumagalli,  Inzani,  Gherini,  Luca  Fattori,  Galignani, 
Parravicini,  Regnoli,  Vanzetti,  Vivante,  Laurenzi,  Gae- 
tano  Bernabeo,  Tansini,  Mugnai,  G.  F.  Novaro,  A. 
Caponotto,  A.  Salomoni,  A.  D'Antona,  F.  Spallitta,  and 

1Policlin.,  Sezione  chirurgica,  1895,  372. 

1  Arch.  ital.  di  Otol,  V,  1897. 

'Riv.  veneta  di  sc.  med.,  1889. 

*Riv.  sper.  di  Jreniat.,  xvm,  1892  and  xx,  1894. 

lRiv.  sper.  di  jreniat.,  1895,  and  Congr.  internat.  de  med.,  Bruxelles,  1897. 

*Gazz.  d.  osp.,  1895. 

'Torino,  1890. 

'Riv.  med.  di.  sc.  med.,  1895,  1,  89. 

'Can.  d.  osp.,  1893. 


224  MODERN  ITALIAN  SURGERY 

Monari.  Most  of  these  surgeons  tried  to  find  the  best 
way  of  reaching  the  gasserian  ganglion,  with  the  least 
disfiguration  of  the  face. 

Rhinoplasty  is  linked  to  the  name  of  Tagliacozzi, 
although  before  him  the  art  of  correcting  deformities 
of  the  nose  was  in  vogue  since  the  year  1440,  particularly 
in  the  southern  part  of  Italy,  where  the  names  of 
Branca,  Boiani,  Vianeo,  Ronzano,  Pavoni  and  Monti- 
gore  were  well  known  before  Tagliacossi.  There  are 
numerous  papers  on  the  subject,  one  of  them  by  Domen- 
ico  de  Luca,  "Su  Vianeo  di  Calabria,  ed  il  Metodo 
Autoplastic©  Italiano"1  may  be  noted.  The  names  of 
Ruggieri  Levi,  Antonio  Lunghi,  Cortesi,  Molinetti, 
Fioravanti,  Carlizzi  and  Marzolo  are  recorded  by 
Giordano  who  could  now  write  some  wonderful  pages 
on  the  work  in  face  reconstruction  during  the  war, 
as  well  as  on  the  subject  of  plastic  surgery. 

The  literature  and  the  practical  contribution  of  Italy 
to  the  surgery  of  the  tongue,  of  the  tonsils  and  salivary 
glands,  is  both  adequate  and  praiseworthy.  Giordano 
narrates:  the  work  of  D.  Biondi,  "Contribute  alia 
plastica  endorale;"2  Valerani,  "Caso  di  macroglossia 
congenita,  felicemente  operato;"3  Gallozzi,  "Iper- 
trofia  della  lingua,  escisione  parziale,  sutura,  guari- 
gione;"4  A.  Nota,  "Delia  macroglossia  in  resoeonto 
clinico  delF  ospedaletto  infantile;"5  Vanzetti,  "Occul- 
tus     linguae     abscessus     oncotomia;"'     Tizzoni    and 

'Napoli,  1858,  Stamperia  deff  I  ride. 

2  Clin,  chir.,  1897. 

*Gior.  d.  r.  Accad.  di  med.  di  Torino,  1876. 

4Morgagni,  1872. 

'Torino,  1894. 

*Ann.  Clin.,  Cnarcoviensis,  1846. 


SURGICAL  LITERATURE  225 

Parona,  "  Contribuzione  alio  studio  dei  tumori  rari 
per  la  Ioro  sede;"1  Remedi,  "Resoconto  clinico;"2 
G.  Corradi,  "Commentario,  1730;"  G.  Fiorani,  "Nuovo 
processo  per  I'amputazione  totale  della  lingua;"3 
Enrico  Bottini,  "La  metodica  amputazione  della 
lingua  dal  cavo  orale;"4  Arturo  Ortuani,  "I  diversi 
metodi  di  amputazione  della  lingua  per  epiteliona 
in  confronto  al  metodo  termogalvanico;"5  E.  Bottini' 
"Le  prima  centuria  di  amputazioni  della  lingua  per 
carcinoma  esequite  colla  dieresi  termogalvanica;"6 
and  Giorgio  Regnoli  preceded  Billroth,  Menzel,  Kocher 
and  Cloquet  in  the  superhyoid  method,  as  related  by 
Ranzi.7 

The  technique  of  Regnoli  was  followed  by  Gianmattei 
of  Lucca,  also  with  good  results. 

Azzio  Caselli:  "Nuovo  processo  per  I'amputazione 
della  Lingua."8 

Gustavo  Usiglio:  "Intorno  a  10  casi  operati  di 
carcinoma  della  lingua."9 

Durante,  has  a  slight  modification  of  the  Regnoli 
method.10 

The  list  grows  in  cases  of  operations  on  the  tonsils 
and  salivary  glands.  We  find  Larghi11  of  Vercelli  advocat- 

1  Ann  di  med.,  March,  1 877. 
1  Siena,  1891,  23-25. 
'Ann.  di  med.,  1882. 
4  Milan,  1874. 

1  Clin,  cbir.,  1897,  Nos.  10  and  II. 
*Clin.  cbir.,  1894. 

7  Nuovo  metodo  per  I'estirpazione  della  lingua  immaginato  ed  esequito  dal 
Professore  Giorgio  Regnoli  ed  esposto  dal  Dott.  Andrea  Ranzi.  Pisa,  1838. 

•  Bvdl.  d.  sc.  med.,  Bologna,  1874. 

•  Riv.  med.  di  sc.  med.,  1890. 

10  Inst.  cbir.  di  Roma,  1886,  33. 
nGazz.  med.  ital.  Prov.  Sarde.,  1861. 
15 


226  MODERN  ITALIAN  SURGERY 

ing  enucleation  of  the  tonsils  with  the  finger,  with  less 
danger  of  hemorrhage.  Biondi  used  scissors  in  preference 
to  the  tonsillotome. 1  T.  G.  Rima  wrote  "Storia  di  un 
voluminoso  tumore  estirpato  dal  collo  di  Marianna 
Talenti."2 

Vanzetti :  *  *  Extirpatio  parotidis . ' ' 3 

G.  B.  Manfredini:  "  Estirpazione  di  due  parotidi."4 

Luigi  Malagodi:  "Sulla  estirpazione  della  ghiandola 
parotide."5 

Valuable  contributions  were  also  given  by  Colomiatti, 
Bertini,  Caselli,  Bidone  and  Dandolo. 

The  subject  of  the  spinal  column  has  been  benefited 
by  an  extensive  literature  from  the  Italians.  V.  Cavagnis, 
antedating  Quincke  and  Chipault,  wrote  on  the  tech- 
nique of  the  sacrococcygeal  puncture  by  means  of  the 
trocar,  so  as  to  draw  off  the  pus  in  cases  of  meningitis 

(1878). 

R.  Muscatello,  Parona,  Ambrogio  Gherini,  Alessandri, 
Achille  Boari,  Mario  Motta,  A.  Turretta,  and  Giuseppe 
Villani  all  contributed  to  spinal  surgery. 

In  the  total  extirpation  of  the  larynx  the  late  Enrico 
Bottini,  Giacomo  Filippo  Novaro,  Giuseppe  Ruggi, 
excelled  although  the  literature  from  other  eminent 
surgeons  is  quite  large:  Chiarella,6  Caponotto,7  A. 
Leonardi,8  and  C.  Orecchia.9 

1Osp.  di  pat.  e  din.  cbir.,  Bologna,  1892. 

2Treviso,  1826. 

'Ann.  din.,  Charcov,  1846. 

4Modena,  1824. 

'Ippocratico  di  Fano,  3,  s.,  xix,  1871. 

'Arch,  ital.  di  laringol.,  1887,  No.  4. 

7Gazz.  d.  din.,  xix. 

'Arch.  ital.  di  laringol.,  1894,  No.  2. 

'Riforma  med.,  1892. 


SURGICAL  LITERATURE  227 

On  the  operation  of  the  esophagus  there  is  a  very 
important  publication  by  A.  Vacca  Berlinghieri:  "Delia 
esofagotomia  e  di  un  nuovo  metodo  di  esequirla."1 
More  recently  articles  have  appeared  by  L.  Ciartoso, 
"SuIIe  stenosi  dell'  esofago;"2  by  G.  Galli,3  who  gives 
a  special  technique,  and  by  G.  F.  Novaro.4 

Thyroid  gland  surgery,  as  Pagello  wrote  in  1888, 
attracted  many  leading  surgeons  of  Italy:  Ruggi; 
CaseIIi ;  Marconi ;  Ceccherelli ;  Dionisio ;  Corradi ;  Bassini ; 
Novaro;  Tansini;  Cacciopoli;  Trombetta;  and  Bottini, 
each  reporting  many  unusual  cases  at  the  sixth  meeting 
of  the  "Societa  Italiana  di  Chirurgia. "  Eugenio 
Casati;  Attilio  Catterina;  Francesco  Golzi;  Giusto 
Pagello;  Martino  Berardino;  Gustavo  Usiglio;  Domen- 
ico  Biondi;  Annibale  Salomoni;  Ercole  Sacchi;  Giulio 
Vassale;  and  Ernesto  Bozzi  have  also  to  their  credit 
various  studies  on  the  thyroid  and  goiter,  and  the 
technique  of  the  operation. 

A  case  of  Basedow's  disease,  successfully  cured  by 
strumectomy,  is  reported  by  Ripamonti,  followed  by 
one  by  Bottini,  and  one  by  Tricomi  who  resected  both 
lobes. 

Michele  Troja  was  the  first  to  devise  a  theory  on 
bone  reproduction  in  his  "De  novorum  ossium  in  inte- 
gris  aut  maximis"  or  "morbus  disperditionibus  regen- 
eratione  experimenta;"5  and  almost  a  century  after, 
Bernardino  Larghi  of  Vercelli  was  the  first  to  put  in 
practice  Troja's  ideas,  "De  I'extraction  sous-periostee 

^isa,  1820 

*  Torino,  Baglione,  1885. 

*Gazz.  med.  di  Tornio,  xxxix,  1888. 

*  Accad.  med.,  February  II,  1891. 
6  Naples,  1775. 


228  MODERN  ITALIAN  SURGERY 

et  de  la  reproduction  des  os;  extraction  sous  periostee 
des  cotes  en  particulier."1 

Italian  surgeons  have  been  justly  proud  of  Michele 
Troja  and  Bernardino  Larghi,  and  of  that  pride  they 
have  given  proof  in  excelling  in  bone  surgery,  especially 
in  the  last  war. 

Few  modern  surgeons  perhaps  know  that  the  great 
Gabriele  Falloppio  in  the  middle  of  the  sixteenth  century, 
while  professor  at  the  University  of  Padua,  had  already 
determined  that  in  the  removal  of  the  breast  for  cancer, 
not  only  all  the  mammary  glands,  but  also  the  mem- 
branes and  the  small  glands  around,  had  to  be  carefully 
removed.  This  rule  was  followed  by  his  pupil  Fabricius 
ab  Aquapendente,  who  realized  intuitively  the  diffusion 
of  the  dreaded  disease.  This  theory  was  scientifically 
confirmed  by  one  of  the  greatest  Italian  pathologists, 
Vittorio  Colomiatti,  in  1874,  in  'Contribuzione  alio 
studio  del  cancro  e  del  tuber colo  e  delFistoIogia  del 
gran  simpatico."2  The  rules  of  Falloppio  were  followed 
by  Angiolo  Nannoni  of  Florence  (1790),  and  by  Giovanni 
Battista  Palletta  (1820),  who  warned  his  colleagues 
against  leaving  suspicious  skin  for  the  sake  of  a  better 
flap.  The  contributions  to  the  study  of  breast  cancer 
and  on  operative  technique  are  considerable  in  Italy, 
but  the  list  would  be  too  long  to  enumerate  here. 

Thoracic  surgery  had  already,  in  the  beginning  of  the 
last  century,  achieved  success  under  CittadiniD'  Arezzo,3 
who  successfully  resected  the  ribs  with  insufflation  of 
air  into  the  lung.  The  rapid  progress  made  lately  in 

1  Gaz.  med.  de  Par.,  June  5,  1847,  434. 

2  Accad.  di  med.  di  Torino,  February  20,  1874. 

3  Com.  Alia  Accademia  Aretina  del  Petrarca,  January  31,  1813. 


SURGICAL  LITERATURE  229 

endothoracic  surgery,  thanks  to  the  wonderful  work  of 
the  lamented  Carlo  Forlanini  and  that  of  his  successor, 
Eugenio  Morelli,  needs  no  illustration  here,  since  their 
discoveries  are  well  known  to  the  American  profession. 
It  has  revolutionized  the  therapy  of  thoracic  diseases, 
as  far  as  the  respiratory  organ  is  concerned,  and  changed, 
to  a  great  extent,  the  surgical  technique  of  pleural  and 
lung  operations. 

Wounds  of  the  heart,  although  rare,  have  been  the 
subject  of  much  discussion  in  Italian  surgical  literature. 
As  early  as  1642,  Tarduccio  Salvi  da  Macerata  in  a 
short  treatise,  "II  Chirurgo,"  defines  wounds  of  the 
heart  as  fatal,  although  Falloppio  and  Valsalva,  prior 
to  that  date,  had  described  cases  of  recovery.  Later  on, 
Morgagni  and  Bianchi  were  decidedly  optimistic  while 
Simplicio  del  Vecchio1  published  a  case  of  successful 
suture  of  the  heart,  as  did  also  Parrozzani,2  Ninni,3  Errico 
Giordano;4  Sironi,  Cappello,  Tassi,  Longo,  Ramoni, 
Arcangeli,  Fummi  and  Tuzzi,  all  of  whom  reported 
similar  cases  of  recovery. 

Intervention  in  the  mediastinum  is  more  practically 
and  successfully  described  by  Marocco;5  and  Raffaele 
Bastianelli6  reports  a  case  of  resection  of  the  manubrium 
of  the  sternum,  so  as  to  remove  a  dermoid  of  the  medias- 
tinum. G.  F.  Novaro,  as  well  as  Errico  Giordano,  re- 
sected part  of  the  sternum  for  tumor  or  abscesses  of  the 
mediastinum ;  likewise,  Parona,  Ruggi,  and  Cavazzani. 

lRiforma  med.,  October,  1898. 

*Accad.  med.  di  Roma,  June  27,  1897. 

'Accad.  med.  cbir.,  Naples,  August  14,  1898. 

*Rijorma  med.,  September  10,  1898. 

*  Torino,  18 14. 

•Societa  Lancisiana,  Osp.  di  Roma,  March,  1893. 


230  MODERN  ITALIAN  SURGERY 

An  important  organ  in  thoracic  surgery  is  the  dia- 
phragm, which  Postempski  of  Rome  opened  through 
the  thorax  to  reach  the  abdominal  cavity.1  Sodo,2 
in  a  case  of  gunshot  wound  piercing  the  thorax,  dia- 
phragm, spleen  and  kidney,  removed  the  bullet  through 
these  organs  with  success. 

Impallomeni,  Amante,  Rossini,  Ninni,  Bignardi,  Curti, 
Sorrentino,  Raimondi,  Maragliano,  and  Corradi  also 
operated  for  diaphragmatic  wounds.  The  abdomen  and 
abdominal  surgery  are  treated  at  length  in  Davide 
Giordano's  book,  and  would  occupy  more  space  had  it 
been  written  after  the  war,  instead  of  in  191 1. 

The  questions  of  early  intervention,  method  of  dress- 
ing, and  after-treatment  have  been  extensively  experi- 
mented with  and  discussed,  and  new  conclusions  have 
been  drawn  which  have  greatly  changed  the  modern 
surgery  of  that  branch,  although  extensive  contributions 
already  existed  on  the  subject  by  Burci,  Carlo  Maglieri, 
F.  Durante,  Errico  Giordano,  Sorrentino,  A.  Nannotti, 
Gesualdo  Clementi,  F.  GuIIotta,  G.  Sorge,  G.  Turrazza, 
E.  Ligniti,  L.  Bonomo  and  F.  Rho,  Luigi  Amabile  and 
Tommaso  Vernicchi. 

Giordano's  book  reviews  the  part  taken  by  Italian 
surgeons  in  the  art  of  sewing  up  the  intestines,  beginning 
with  the  original  method  of  Nicola  D'ApoIito,  of  which 
a  full  description  is  given  in  the  "Treatise  of  the  Surgical 
Operations  of  Panzetta."3  He  enumerates  the  various 
modifications  proposed,  the  Murphy  button,  and  the 

1  Postempski  anf  Manara.  Soc.  ital.  cbir.  di  Bologna,  April  16,  1889,  and 
Riforma  med.,  1890,  1,  647. 

2  Ferita  d'arna  da  fuoco  del  torace  e  delFaddome;  splenectomia  e 
nefrectomia,  occlusione  secondaria  delFintestino;  secondo  intervento,  guari- 
gione.  Riforma  med.,  1896,  iv,  411. 

3 11,  269,  Naples,  1867. 


SURGICAL  LITERATURE  231 

other  original  methods — those  of  Burci,1  Morisani,2 
Parlavecchio,3  Errico  Giordano4  and  R.  Marponi.5 

In  gastric  surgery  Giordano  mentions  first  P.  Loreta 
as  an  original  pioneer.6  G.  F.  Novaro,7  A.  Caponotto,8 
and  Ancona,  also  Codivilla,  Caporale,  Panzeri,  Faller- 
oni,  and  Postempski  all  eulogize  Loreta's  method.  In 
France,  Jules  Genevrier9  reports  47  cases  of  permanent 
cures  in  65  cases  operated  by  Loreta's  method. 

After  that  follows  a  summary  of  the  results  of 
surgical  invervention  by  pyloroplasty,  well  illustrated 
by  Lodovico  Corazza.  In  Giordano's  note  on  51  cases  of 
pyloroplastic  surgery,  22  of  which  belong  to  Italian 
surgeons,  are:  Novaro,  6;  Postempski,  5;  Carle,  3; 
Colzi,  3;  Durante,  2;  Falleroni,  Ceccherelli  and  Corazza, 
one  each.  Novaro,10  A.  Ceccherelli,11  F.  Durante,12  and 
A.  Carle13  have  given  accounts  of  the  method. 

I  Sul  saldamento  della  mucosa  intestinale  rawicinata  mediante  sutura. 
Cong,  della  soc.  ital.  di.  cbir.,  October,  1897. 

8  Uber  einen  neuen  Operation  Invaginationsprocess  bei  Geradlinigen  Dar- 
manastomosen,  Centralbl.  j.  cbir.,  1899. 

*  Nuovo  metodo  per  Ie  enteroanastomosi  nell'asse,  e  Iaterali,  per  Ie  gastro 
e  Ie  colecisto-enterostomie.  11  Policlin.,  Sezione  chirurgica,  1898,  180,  376,  429. 

*Gazz.  internaz.  di  med.  prat.,  January,  February,  1899. 

i  Suture  coefficient!  ai  progressi  della  chirurgia  intestinal.  Clin.  Cbir., 
1899,  30. 

8  La  divulsione  digitale  del  piloro  e  la  divulsions  strumentale  del  I'esofago 
e  del  cardias,  invece  della  gastroctomia.  Mem.  Lette.  alia  Accad.  d.  1st.  d. 
soc.  Med.  di  Bologna,  Treves,  1884. 

7  Commemorarazione  di  Loretta,  Bologna,  1892. 

8  Regia  Accad.  di  med.  di  Torino,  January,  1885. 

•  Thes.  de  Lyon,  1899. 

10  Contribuzione  alia  chirurgia  dello  stomaco,  1888,  14. 

11  Intervento  chirurgico  nelle  malattie  dello  stomaco.,  Confer,  clin.  ital., 
Milan,  1  s.,  II,  No.  3,  1898. 

II  Considerazioni  sui  ristringimenti  pilorici  e  Ioro  cura.  Policlin.,  Roma,  July 
15,  1894. 

18  Contribuzione  alia  chirurgia  dello  stomaco.  Cong.  Med.  internaz.,  Roma, 
1894;  and  Chirurgia  vie  digerenti.,  Cong.  soc.  di  chir.  Rijorma  med.,  1895,  iv,  374. 


232  MODERN  ITALIAN  SURGERY 

Before  gastroenterostomy  was  adopted  in  France  it 
was  already  practiced  by  Novaro,  Caponotto,  Giordano, 
Anglesio  in  Turin,  and  by  Postempski  in  Rome. 

If  the  contribution  of  Italian  surgeons  to  gastric 
surgery  and  to  the  surgery  of  the  intestinal  tract  is 
large,  still  larger  is  that  to  the  surgery  of  the  liver,  which 
starts  from  Fabricius  ab  Aquapendente  and  comes  down 
to  Fabio  Vitali,  Luigi  Ferrarini,  F.  de  Filippi,  E.  Bozzi, 

A.  Caldarelli,  Pietro  Ferrari,  Davide  Giordano,  Raffaele 
Bastianelli,  Comandini,  E.  Salvolini,  Luigi  de  Gaetano, 
Prospero  Guidone,  Mazzarini,  Clementi,  Micheli,  J.B. 
Bianchi,  Marchetti,  Molinelli,  M.  G.  Levi,  Gaetano 
Paolucci,  Ughetti,  D.  Biondi,  Ciaramelli,  A.  Sgambati, 
Sergio  Pansini,  Raffaello  Silvestrini,  Enrico  Burci, 
G.  Usiglio,  Giuseppe  Beisone,  Luigi  Soave,  Luigi  Rieppi, 
Ghendini,  E.  Terrile,  Antonio  Leonardi,  Guido  Cavaz- 
zani,  Giacinto  Viola,  Bindo  de  Vecchi,  Rovighi,  S. 
Castellani,  F.  Fiorioli,  Delia  Lena,  Achille  Boari, 
Cimbali,  V.  Piazza  and  Martini,  some  of  these  surgeons 
dealing  especially  with  abscesses  and  echinococcus  of 
the  liver. 

In  the  field  of  hepatic  calculus  there  are  extensive  and 
valuable  contributions  by  Aristide  Mattoli,  A.  Dandolo, 

B.  Schiassi,  Annibale  Salomoni,  Ciro  Delia  Rosa,  U. 
Monari,  C.  Pantaleoni,  P.  Grocco,  L.  Mazzotti,  Giuseppe 
Jona,  Canali,  Griffini,  Colucci,  Petrone,  Francesco 
Fiore,  E.  Matteo  Giancola,  Giulio  Filippini,  J.  B. 
Segale  and  Luigi  Baldassari;  likewise  to  the  literature 
on  the  pancreas,  to  which  Filippi,  Mazzoni,  Dandolo, 
Vincenzo  Giudiceandrea,  Michele  Titone,  Giordano, 
Ruggi,  Biondi,  A.  Mugnai,  E.  Tricomi  and  A.  M. 
Luzzato  have  contributed. 


SURGICAL  LITERATURE  233 

Concerning  the  spleen,  Giordano  refers  to  Leonardo 
Fioravanti,  who,  in  April,  1549,  performed  the  extirpa- 
tion of  a  vuluminous  spleen  successfully,1  and  follows 
with  a  long  list  of  contributors:  Massapust  of  Triest; 
Eriberto  Aievoli;  Bernardino  Martino;  Carlo  Cangitano 
(reporting  39  cases  of  splenectomy  with  13  deaths); 
Maffucci  and  Montenovesi;  Angelo  Pugliese;  A.  Ceci; 
Gaetano  Bragagnolo;  G.  Tedeschi;  Timoteo  Valeggia; 
Carlo  Mariani;  A.  Nannotti;  A.  Turretta;  G.  D'Urso; 
A.  Raffa;  F.  Brancaccio  and  A.  Solaro;  A.  Parona; 
Jemoli;  A.  Pizzorno;  Aurelio  Cordero;  Guerra;  E. 
Mercandino;  Luigi  Guida;  Giovanni  Cirillo  and  Gio- 
vanni Pirn. 

Tubercular  peritonitis  has  also  been  the  subject  of 
many  contributions  by  B.  Martino;  L.  Soave;  Enrico 
D'Anna;  Filiberto  Casinari,  and  M.  Jorfida  who  gath- 
ered 270  bibliographic  notes  on  that  subject. 

The  name  of  Edoardo  Bassini  is  placed  first  on  the 
list  for  the  surgical  treatment  of  inguinal  hernia,  as  the 
exponent  of  a  special  method  of  operation  well  known 
throughout  the  world.  The  list  is  followed  by  many 
other  well-known  names:  A.  di  Giacomo;  D.  Morisani; 
G.  Cacciopoli;  Rodolfo  Canepa;  Angelo  Roth;  Martino; 
Usiglio;  Penzo;  Ciro  Delia  Rosa;  P.  Tansini;  Giulio 
Filippini;  Garampazzi;  Postempski;  A.  Mugnai;  Pietro 
Ferrari;  Ruggi;  Golzi;  Galliani;  Stecchi;  Bonomo;  Tri- 
comi;  Parlavecchio;  Ferrari  and  Racco. 

Gynecology  is  the  field  upon  which  Giordano  dwells 
extensively  as  a  part  of  surgery  in  which  most  of  the 
leaders  in  general  surgery  participate — men  like  Bottini, 

1  Compendio  di  Tutta  La  Chirugia.  Di  Leonardo  Fioravanti,  Bolognese. 
Venice,  mdclxxvii,  364. 


234  MODERN  ITALIAN  SURGERY 

Paci,  Bompiani,  Caselli,  Bellini,  Peruzzi,  Novaro, 
Ruggi,  Berruti,  Bergesio,  with  an  extensive  nomencla- 
ture of  cases,  original  methods,  and  modifications  of  well- 
known  methods  of  national  and  foreign  origin.  He 
mentions  an  old  treatise  of  Giovanni  Marinelli — "Le 
medicine  pertinenti  alle  infermita  delle  donne,"1 
reviewing  down  to  the  present  time  the  important 
works  of:  Ruggi;  Caponotto;  Peruzzi;  Turrazza;  Moris- 
ani;  Pestalozza;  Delia  Rosa;  De  Cristoforis;  Casati; 
Libero  Bergesio;  Porro;  Bompiani;  Frattina;  Velo;  Cal- 
derini;  Acconci;  Inverardi;  Truzzi,  and  Mangiagalli,  the 
illustrious  organizer  of  the  Scientific  Institute  of  Milan. 
Urology  also  offers  a  large  field  to  Italian  surgeons, 
in  which  they  have  produced  abundant  material  on  the 
surgery  of  the  kidney,  the  ureter,  the  bladder,  the 
urethra,  and  the  connecting  organs.  An  important 
publication  by  the  author  of  the  book,  Davide  Gior- 
dano,2 gives  an  outline  of  the  progress  made  at  that 
time;  and  two  others,  one  by  Ceccherelli3  and  one  by 
Carmelo  Bruni4  tell  of  what  has  been  done  in  Italy  on 
urology.  Beside  the  surgeons  above  mentioned,  many 
others  wrote  and  specialized  in  that  branch:  Nicola 
Giannattasio;  Francesco  Mastrosimone;  Italo  Anto- 
nelli;  L.  Sottocasa;  Cesare  Zatti;  Dario  Maragliano; 
Alessandro  Cantieri;  A.  Michelazzi;  Augusto  Luxardo; 
Francesco  Fabris;  Giulio  Anzillotti;  Ermanno  Fioretti; 
A.  Rovighi;  Paolo  Fiori;  Giuseppe  Del  Fabro;  Baldo 
Rossi;  Erasmo  de  Paoli;  G.  Pesenti;  Pietro  Pozza;  Ugo 

1  Venice,  De  Franceschi  Senese,  1563,  174-178. 

2  Chirurgia  renale.  Torino,  Unione  Tipografica,  1898. 

3  Progressi  recenti  nella  patologia  e  terapia  degli  organi  genito  urinari; 
Imparziale  Anno  23. 

4  Gli  Italiani  e  i  progressi  recenti  nella  chirurgia  delle  vie  urinarie. 


SURGICAL  LITERATURE  235 

Pisani;  Fernando  Franzolini;  Luigi  Ferria;  Corradi; 
A.  Tommasini  Degna;  Giusto  Pagello;  Giuseppe  Pacci- 
notti;  Annibale  Nota  and  G.  Dalle  Ore. 

The  male  genital  organs  are  subject  to  so  many 
diseases  that  the  nomenclature  of  each  would  fill  many 
pages.  Phimosis,  epididymitis,  orchitis,  hydrocele,  vari- 
cocele and  their  varieties,  tuberculosis  of  the  testis  in 
its  different  forms,  from  Guglielmo  Da  Saliceto  to  the 
present  day,  have  been  subject  to  so  many  modifications 
as  to  the  different  methods  of  treatment,  that  perhaps 
modern  surgery  has  become  more  conservative.  Nicolo 
Trevisan,  Oscar  Bardella,  Mario  Fasano,  Alberto 
Marrassini,  G.  Pascale,  A.  Poggi,  Ingianni,  Arpini, 
D'Urso,  E.  Torcello,  A.  Ferraro,  Mario  Donati,  M. 
Belli,  O.  Schifone,  Filippo  Carta,  Giorgio  Paci,  Carlo 
Viscontini,  Giuseppe  Bennassi,  Enrico  Nespoli,  Dante 
Boni,  C.  Parrini,  Giovanni  Melchiori,  Silvio  Roland i 
and  Pasquale  Landi  are  all  authors  of  interesting 
studies  and  statistics  of  operations  performed. 

The  surgery  of  the  anus  and  rectum  has  made  great 
progress,  in  the  method  of  treatment,  at  the  hands  of 
Italian  surgeons,  among  whom  Giardano's  book  men- 
tions Cittadini  D'Arezzo,1  Angiolo  Filippi,2  G.  Mioni,3 
Giuseppe  Flajani,4  Antonino  Virdia,5  Francesco  Reali, 
Giuseppe  Cavallini,6  D.  Fieschi7  and  Vincenzo 
Meirocco.8 

1  Due.  Clin.,  xxix. 

1  Sperimentalc,  1 869. 

*Gazz.  d.  osp.  No.  152,  1905.. 

4CoIIezione  di  osservanzioni  e  riflessioni,  Roma,  1803. 

1  Chirurgia  rettale,  analc,  Napoli,  1900. 

•  Firenze,  1762. 

7  Isolamento  del  retto,  1908. 

1  Trattamento  emorroidi  interne.  Gazz.  med.  di  Torino,  1885. 


236  MODERN  ITALIAN  SURGERY 

In  the  final  review  of  his  book,  Giordano  deals  with 
the  surgery  of  the  lower  limbs  and  again  refers  to  that 
great  teacher  and  operator,  Bernardino  Larghi,  who 
has  contributed  so  largely  to  general  surgery  (Incisione 
unica,  ossia  nuovo  metodo  per  la  rescissione  della 
testa  del  femore  e  per  la  disarticolazione  della  coscia 
dal  bacino.1  In  his  book2  Giordano  notes  his  successful 
case  with  illustrations,  then  proceeds  to  demonstrate 
what  other  surgeons  did  in  hip  diseases  and  operations. 

He  mentions  Remigio  Stecchi3  and  Alessandro  Codi- 
villa,4  and,  on  the  same  subject,  Gaetano  Tarchetti,6 
who,  dividing  his  work  into  regions,  reports,  in  discus- 
sing the  knee,  Vanzetti's  resection  in  1865  (that  is  in 
an  epoch  pric**  to  Lister)  in  which  Tarchetti  used 
creosote  dressing,  as  did  also  Franzolini,  injecting  a 
concentrated  solution  of  carbolic  acid.  Extensive  and 
valuable  contributions  have  been  recorded  by  G.  F. 
Novaro,  Erasmo  de  Paoli,  Andrea  Ceccherelli  (1883), 
Azzio  Caselli,6  Ciro  Delia  Rosa,7  F.  Durante,8  Poggi9 
and  Alberto  Finelli.10 

Giving  special  mention  to  Larghi,  who  preceded 
Obalinski   in  the   resection   of  the  tarsus,   Giordano 

1Gior.  d.  Accad.  di  med.,  Torino,  1855. 

2  PArtrectomia  delFanca  e  cura  della  coxite.  Clin,  cbir.,  1898,  No.  9. 

3  Sulla  coxite  tubercolare,  contribuzione  alia  cura  col  metodo  Giordana. 
Supplemento  Policlin.,  1 90 1. 

4Trattamento    Iussazioni    traumatiche    inveterate    dell'anca    dell' adult  o, 
Arch,  di  ortop.,  1902. 
6Venezia,  1904. 
6SuIIe  resezioni,  collezioni  Ietture,  No.  8,  August,  1881. 

7  Sessanta  casi  di  chirurgia  del  ginocchio.  Riv.  med.  di  Venezia,  1898. 

8  Nuovo  processo  operativo  per  la  resezione  del  ginocchio.  Bull.  Accad.  di 
Roma,  1886. 

9  Resezione  del  ginocchio.  Cong,  di  Pavia,  1887. 

10  Nuovo  processo  artrotomia  del  ginocchio,  Napoli,  1902. 


SURGICAL  LITERATURE  237 

reviews  the  work  of  Gritti,  Rocco,  Giuseppe  Cacciop- 
poli,  E.  Albanese,  A.  Caselli,  and  Angelo  Negretto,  who 
treated  the  subject  from  a  broad  original  aspect. 

On  clubfoot  surgery  Giordano  quotes  Mario  Motta  of 
Turin,1  Davide  Giordano,2  Giuseppe  Frattin  (Plastica 
Ortopedica),3  C.  Ghillini,4  Pietro  Cavatorti,5  and  Fedele 
Margary.6 

Reviewing  the  progress  of  surgery  in  the  interven- 
tion in  nervous  lesions  of  the  lower  limbs,  following 
principally  upon  infantile  paralysis,  Giordano  mentions 
G.  Cacciopoli,  Cappelli,  Rossi  and  Salaghi,  in  their 
contribution  to  the  treatment  of  paralytic  feet  in 
children,7  and  devotes  special  mention  to  A.  Codivilla,8 
Lorenzo  Cappelli,9  and  Baldo  Rossi,10 

Giordano  closes  with  an  article  on  varicose  veins, 
summarizing  the  method  of  Pietro  E.Lodovico  Rostini,11 
and  those  of  Cels,12  Delia  Croce,13  A.  Tiraboschi,14  L. 

iPolyclin.,  1890. 

*  Piedi  equini  vari  altissimo  grado  correzione  con  resezione,  etc.  Arch, 
di  ortop.,  1889. 

*  Riv.  sc.  med.,  Venezia,  1910. 

4  Trattamento  piede  torto.  Bull.  soc.  med.,  Bologna,  1903. 

6 1,   piedi   torti,    studio  anatomico  clinco.  Arch,  internat.  de  cbir.,   1904. 

•  Estirpazione  Astragalo,  1886. 

I  Riv.  crit.  di  clin.  med.,  xvm,  No.  8,  1917. 

•  I'  trattamento  chirurgico  della  paralisi  infantile  spinale.  Policlin.,  vii 
Sezione  chirurgica,  1900. 

•Trapianto  tendineo  nella  cura  di  un  caso  di  paralisi  da  poliomielite 
anteriore  acuta — qualche  considerazione  suIPargomento.  Policlin.  Sezione 
practica,  1902. 

10 1  Trapianti  tendinei  nella  practica  chirurgica.  Milan,  Tipografia  Guidetti 
e  Mondini,  1904. 

II  Compendio  di  Tutta  la  Chirurgia.  Venezia,  1677,  128. 
11  Lib.  vii,  Cap.  xxii,  De  Varicum  Curatione. 

u  Lib.  iv.,  Delle  Piaghe,  Cap.  lxvii,  Delle  varici  e  della  cura  Ioro. 
14  Psicosi  la  cicatrizzazione  di  annosa  ulceia  wella  gamba.  Risveglio  med. 
(fAbruzzo,  December  20,  1909. 


238  MODERN  ITALIAN  SURGERY 

Rebaudi,1  G.  B.  Palletta,2  Tommaso  Rima,3  T,  Volpi,4 
Raffaele  Cecca,5  B.  Schiassi6  and  A.  Moreschi.7 

Finally,  Giordano,  with  "un  nuovo  metodo  piu 
semplice  di  curare  Ie  Iesioni  varicose  delle  gambe, 
secondo  il  concetto  di  Moreschi,"8  closes  his  big  and 
important  volume  (Compendio  Di  Chirurgia  Operativa 
Italiana),  leaving  in  the  mind  of  every  Italian  surgeon 
the  hope  that  he  will  soon  publish  an  appendix  dealing 
in  the  great  work  done  by  Italian  surgeons  during 
the  Great  War. 

1  Dell'obliterazione  delle  vene  come  mezzo  curativo  delle  varici.  Arch.  gen.  di 
med.,  Maggio,  1833. 

2  Considerazioni  sopra  Ie  varici.  Diz.  clin.  xlvih,  659. 

3  Sulla  causa  prossima  delle  varici  alle  estremita  inferiori  e  sulla  loro  cura 
radicale.  Venezia,  Presso  Antonelli,  1838. 

4  Delle  cura  radicativa  delle  varici  alle  gambe.  Di.  clin.  clviii,  609. 

6  Nuovo   metodo   operativo   per   la   cura  delle  varici.  Bull.  d.  sc.  med., 
Bologna,  1906,  vi. 

8  La  cure  des  varices  du  membre  inferieur  par  F  injection  intraveineuse 
d'un  solution  d'iode.  Semaine  med.,  December  16,  1908. 

7  II  mio  processo  per  la  cura  delle  varici  ed  ulceri  varicose  gli  arti  inferiori 
Riforma  med.,  1894,  No.  48;  Clin.  Cbir.,  No.  2.,  1899. 

*Gazz.  d.  osp.,  No.  151,  1899. 


INDEX 


INDEX 


Abbate,  E.,  114 

Acconci,  234 

Achillini,  Alessandro,  104 

Aducco,  Vittorio,  179 

Ageno,  Luigi,  172,  173 

Aievoli,  Eriberto,  233 

Ajello,  Abele,  207 

Albanses,  Enrico,  75,  93,  237 

Albertini,  156 

Alberto,  Carlo,  3,  10,  163,  165 

Alciato,  147 

di  Alderotto,  Taddeo,  103 

Aldrovandi,  123 

Alessnadri,    Roberto,   42,    117, 

119,  215,  226 
Alfonso  of  Aragon,  207 
Allegra,  Stefano  Puglisi,  209 
Allessandrini,  81 
Amabile,  Luigi,  230 
Amante,  230 
Amar,  69 

Amedeus  II,  Victor,  165 
Ancona,  231 
Angelico,  Fra,  188 
Antonelli,  Italo,  234 
Antenor,  138,  140 
Anzillotti,  Giulio,  234 
Aranzi,  Giulio  Cesare,  105,  127 
Arcangeli,  Umberto,  121,  229 
Archimedes,  102 
Arcoleo,  Eugenio,  207 
Armstrong,  197 
Arpini,  235 
Aselli,  Gasparo,  106 
Attila,  138 
Auer,  133 

Baccelli,  Guido,  95,  116,  215 
Baiardi,  Daniele,  166,  168 


Baker,  George  F.,  25 

Baldassari,  Luigi,  232 

Balli,  126 

Banti,  Guido,  148,  189,  217 

Bardella,  Oscar,  235 

Barellai,  74 

Basedow,  227 

Bassi,  Ugo,  123 

Bassini,  Edoardo,  94,  98,  141,   185, 

227,  233 
Bastianelli,  Raffaele,  19,  38,  41,  42, 

119,  120,  229,  232 
Baviera,  Vincenzo,  207 
Beisone,  Giuseppe,  232 
Belfanti,  Serafmo,  160 
Belli,  M.,  235 
Bellini,  234 
Bembo,  141 
Benedict  XIII,  165 
Benedetto,  Umberto,  208 
Benevoli,  220 
Bennassi,  Giuseppe,  235 
Berardino,  Martino,  227 
Berengario,  220 

Bergamasco,  Giovanni  Passe  ro,  219 
Bergesio,  Libero,  100,  234 
Berlinghieri,  A.  Vacca,  227 
Bernabeo,  Gaetano,  223 
de  Bernardi,  Lorenzo,  169 
Berruti,  234 
Bertarelli,  Ernesto,  160 
Bertini,  226 
Bertrandi,  220 
Betagh,  Giuseppe,  209 
Bianchi,  J.  B.,  229,  232 
Bidone,  226 
Biffi,  126 

Bignami,  Amico,  121 
Bignardi,  230 


241 


242 


INDEX 


Biondi,  Domenico,  183,  184,  185,  224, 

226,  227,  232 
Billroth,  Theodor,  194,  225 
Binaghi,  Roberto,  210,  211 
Biumi,  Gerolamo,  155 
Bizzozzero,  Giulio,  107,  217 
Boari,  Achille,  99,  121,  232 
Bobbio,  Luigi,  168 
Boccaccino,  140 

Boccasso,  Giovanni,  Battista,  169 
Boethius,  145 
Boiani,  224 
Bompiani,  234 
Bonardi,  Edoardo,  160 
Boni,  Dante,  235 
Boni,  Giacomo,  in,  112 
Boniface  VIII,  115 
Boniface  IX,  146 
Bonomo,  Lorenzo,  34,  230,  233 
Bossi,  Luigi,  100 
Bottallo,  96,  106 
Bottini,  Enrico,  93,  98,  147,  215,  225, 

226,  227,  233 

Bozzi,  Ernesto,  38,  42,  99,  175,  176, 

227,  232 
Bozzolo,  Camillo,  95 
Bracci,  214 

Brady,  Nicholas  F.,  25 

Bragagnolo,  Gaetano,  233 

Branca,  224 

Brancaccio,  F.,  233 

Broca,  221 

Bruni,  Carmelo,  234 

Bruno,  Giordano,  193 

Bufalini,  216 

Burci,  Enrico,  44,  49,  185,  189,  190, 

214,  231,  232 
Busi,  Aristide,  126 

Cacciopoli,  Giuseppe,  99,  227,  233, 

237 
Calabrese,  38,  94 
Caldani,  Leopoldo,  127 
Caldarelli,  Antonio,  95,  232 
Calderini,  99,  234 


Calori,  Luigi,  128 

Calvi,  Felice,  155 

Calzavara,  Clemente,  207 

Camera,  Ugo,  41,  169 

Camminiti,  Rocco,  195 

Canali,  232 

Canavesi,  Gaetano,  155 

Canepa,  Rodolfo,  233 

Cangitano,  Carlo,  233 

Cantieri,  Alessandro,  234 

Caponetto,  Gaetano,  208 

Caponotto,  A.,  223,  226,  234 

Caporale,  231 

Cappelli,  Lorenzo,  237 

Cappello,  229 

Carbonai,  Ferdinando,  74,  75,  76,  83 

Carcano,  Leone,  G.  B.,  147,  219 

Carle,   Antonio,  94,    132,    167,    168, 

231 

Carlizzi,  224 

Carmine,  90 

Carnelli,  Antonio,  155 

Carozzi,  159 

da  Carpi,  Berengario,  104,  127 

Carrel,  41 

Carrel-Dakin,  14 

Carta,  Filippo,  235 

Casati,  Eugenio,  227,  234 

Caselli,   Azzio,    173,   225,   226,   227, 

234,  236,  237 
di  Cavour,  Camillo  Benso,  4,  10,  130, 

163 
Casinari,  Filiberto,  233 
Cassanello,  Rinaldo,  179 
Casserio,  Giulio,  106 
Cassini,  Eugenio,  121 
Castellani,  S.,  232 
Castracane,  Castruccio,  179 
Cattaneo,  Carlo,  2 
Catterina,  Attilio,  175,  227 
Cavagnis,  V.,  226 
di  Cavallerleone,  Luigi  Ferrero,  40 
Cavallini,  Giuseppe,  235 
Cavatorti,  Pietro,  237 
Cavazzani,  Guido,  229,  232 


INDEX 


243 


Cecca,  Raffaele,  238 

Ceccherelli,   Andrea,    135,   215,   222, 

227,  231,  234,  236 
Ceci,  Antonio,    136,    179,    180,   218, 

233 

Cels,  237 

CesaJpino,  103,  141 

Charlemagne,  122,  146 

Charles  IV,  146 

Charles  V,  182 

Chevelley,  50 

Chiarella,  226 

Chiarugi,  Giulio,  189,  217 

Chrpault,  226 

Ciaramelli,  232 

Ciartoso,  L,  227 

Cimbali,  232 

Cirillo,  Giovanni,  233 

Cirincione,  Giuseppe,  1 19 

Clavini,  161 

Clementi,    Gesualdo,    94,    207,    230, 

232 
Clivio,  Innocente,  100 
Cloquet,  225 
Codivilla,  Alessandro,  89,  222,  231, 

236,  237 
Cohnheim,  117 
Colombo,  Cristoforo,  170 
Colombo,  Matteo  Rialdo,  102,  105 
Colomiatti,  Vittorio,  226,  228 
Colonna,  113 
Colucci,  232 

Colzi,  Francesco,  189,  231 
Comandini,  232 
Corazza,  Lodovico,  231 
Cordero,  Aurelio,  233 
Corradi,  Giuseppe,  116,  189,  225,  227, 

230,  235 
Corradino,  178 
Correggio,  134 
de  Cortes,  Antonio,  211 
Cortesi,  Giovanni  Battista,  220,  224 
Costa,  Annibale,  208 
Couillaux,  Lodovico,  160 
de  Cristoforis,  Malachia,  156,  234 


della  Croce,  Andrea,  219,  237 
Croce,  Benedetto,  197 
Crivelli,  Girolamo,  155 
Curti,  230 

D'Anna,  Enrico,  233 

D'ApoIito,  Nicola,  230 

DalTAcqua,  Ugo,  143 

Dandolo,  A.,  226,  232 

D'Annunzio,  Gabriele,  6 

Dante  Alighieri,  2,  5,  no,  163,  179, 

188 
D'Antona,  Antonino,  94,    183,    194, 

195,  196,  205,  209,  221,  223 
Danysz,  40 

D'Arezzo,  Cittadini,  228,  235 
Da  Saliceto,  Guglielmo,  235 
De  Amicis,  Edmondo,  199,  200 
De  Castro,  1 1 1 
Degna,  A.  Tommasini,  235 
Del  Fabro,  Giuseppe,  234 
Del  Greco,  161 
Deliberti,  Salvatore,  207 
Delia  Lena,  232 

Delia  Rosa,  Ciro,  232,  233,  234,  236 
Delia- Vedova,  119 
Del  Vecchio,  Simplicio,  229 
De  Paoli,  Erasmo,  94,  176,  213,  214, 

234.  236 
D'Este,  Beatrice,  146 
Dettori,  Vincenzo,  212 
Devoto,  Luigi,  158,  160 
De  Vecchi,  Paolo,  12,  93 
Dionisio,  Ignazio,  99,  227 
Donatello,  140 

Donati,  Mario,  41,  94,  132,  133,  235 
Doria,  Andrea,  170 
Dunant,  Henri,  159 
Durante,  Francesco,  41,  44,  116,  117, 

149,  211,  215,  217,  225,  230,  231, 

236 
D'Urso,  Gaspare,  209,  233,  235 

Emanuel  III,  Carlo,  165 
Emanuel  II,  Victor,  130,  163 


244 


INDEX 


Emanuel  III,  Victor,  10,  1 1 

Enzo,  131 

Euclid,  102 

Eustachio,  Bartolomeo,  105,  106 

Fabricius    ab    Aquapendente,    Hier- 

onymus,  96,  102,  105,  141,  219, 

228,  232 
Fabris,  Francesco,  234 
della  Faggiuola,  Uguccione,  178 
Falleroni,  231 
Falloppoi,  Gabriele,  96,  105,  106,219, 

228,  229 
Fantino,  167 
Fasano,  Mario,  235 
Fasoli,  Gaetano,  160 
Fattori,  Luca,  223 
de   Felice-Ghiffrida,  Guiseppe,  202, 

203 
Ferdinand  I,  135 
Ferlito,  Carmelo,  208 
Ferraresi,  Oreste,  121 
Ferrari,  Pietro,  222,  232,  233 
Ferrarini,  Guido,  179,  180 
Ferrarini,  Luigi,  232 
Ferraro,  A.,  235 
Ferreri,  Gherardo,  99,  119 
Ferria,  Luigi,  235 
Ferrier,  221 
Ferroni,  Ersilio,  100 
Fichera,  Gaetano,  211,  216 
Fieschi,  D.,  235 
Filippi,  Angiolo,  235 
de  Filippi,  F.,  232 
Filippini,  Giulio,  232,  233 
Finelli,  Alberto,  236 
Fiorani,  Giovanni,  98,  218,  225 
Fioravanti,  Leonardo,  224,  233 
Fiore,  Francesco,  232 
Fioretti,  Ermanno,  234 
Fiori,  Paolo,  133,  234 
Fiorini,  126 
Fiorioli,  F.,  232 
Flajani,  Giuseppe,  235 
Forlanini,  Carlo,  95,  150,  152,  229 


Forni,  Gherardo,  39 

Fra  Angelico,  188 

Francis,  132 

Franzolini,  Fernando,  235,  236 

Frattin,  Giuseppe,  237 

Frattina,  234 

Frederich  II,  104,  192 

Fumagalli,  223 

Fummi,  229 

Fusari,  Romeo,  217 

de  Gaetano,  Luigi,  195,  232 
Galeazzi,  Riccardo,  80,  89,  90,  94, 

160,  161 
Galen,  102 
Galeotti,  Gino,  217 
Galignani,  223 

Galileo,  Galilei,    102,    103,  141,  179 
Galli,  G.,  227 
Galliani,  233 
Galliera,  de  Ferrari,  171 
Gallozzi,   Carlo,   41,    183,    194,   224 
Galvani,  123 
Gamba,  76,  77 
Ganfini,  Carlo,  173 
Garampazzi,  233 
Garau,  Angelo,  211 
Gardini,  Ulisse,  126 
Garibaldi,  Giuseppe,  4,  6,   10,    123, 

130,  192,  199,  202 
Garofalo,  140 
Gatti,  Gerolamo,  190 
Genevrier,  Jules,  231 
da  Genova,  Anselmo,  220 
Ghendini,  232 

Gherini,  Ambrogio,  223,  226 
Ghillini,  G,  237 

Giacomini,  Carlo,  106,  165,  221,  223 
di  Giacomo,  A.,  233 
Giacosa,  Piero,  161 
Gianantoni,  214 
Giancola,  E.  Matteo,  232 
Gianmattei,  225 

Giannattasio,  Nicola,  41,  191,  234 
Gioberti,  Vincenzo,  2 


INDEX 


245 


Giordano,  Davide,  40,  99,  217,  218, 
220,  222,  223,  230,  232,  233,  234, 
236,  237,  238 

Giordano,  Errico,  229,  230,  231 

Giordano,  Vincenzo,  212 

Giotto,  140,  188 

de  Giovanni,  Achille,  95 

Giudiceandrea,  Vincenzo,  232 

Giuliano,  Ottaviano,  208 

Giuntini,  220 

Giuriati,  53 

Gladstone,  199 

Godlee,  Rickman  John,  93,  94,  118, 
124 

Golgi,  Camillo,  152 

Golzi,  Francesco,  227,  233 

Gordon,  Lina  Duff,  213 

Gozzoli,  Benozzo,  188 

Gradenigo,  Giuseppe,  99,  223 

da  Grado,  Matteo,  104 

Griffini,  232 

Gritti,  237 

Grocco,  Pietro,  95,  232 

Guarnieri,  Giuseppe,  179 

Guali,  21 

Guerica,  Pier  Michele,  173 

Guida,  Luigi,  233 

Guidone,  Prospero,  232 

Gullotta,  F.,  230 

Gurerra,  233 

Guzzardi,  Michele,  208 

Harvey,  William,  102,  106,  141 
Heiser,  Victor  G.,  12,  15,  25 
Henry  VII,  144 
Hippocrates,  102 
Huntington,  Thomas  W.,  12,  25 

Ibanez,  V.  Blasco,  200 

Impallomeni,  Giovanni,  121,  230 

Ingianni,  235 

Ingrassia,  Giovanni  Filippo,  96,   105 

Introsofista,  Cassio,  220 

Inverardi,  234 

Inzago,  Cristeforo,  155 


Inzani,  223 
Isaia,  Angelo,  209 
Isnardi,  Lodovico,  168,  223 

Jacobelli,  Filiberto,  195 
Jemoli,  233 
Jona,  Giuseppe,  232 
Jorfida,  M.,  233 

Kocher,  98,  225 

Labriola,  Arturo,  197 

Lachi,  Pilade,  173 

Lagerlof,  Selma,  199,  200 

Lanciani,  Rodolfo,  1 1 1 

Landi,  Pasquale,  123,  235 

Lanfranchi,  106 

Larghi,  Bernardino,  40,  98,  225,  227, 

228,  236 
Lasio,  161 
Laurenzi,  223 
Lautrec,  146 

Leonardi,  Antonio,  226,  232 
Leopardi,  Giacomo,  193 
Levi,  M.  G.,  232 
Levi,  Ruggieri,  224 
Ligniti,  E.,  230 

Lister,  93,  94,  98,  118,  124,  236 
de  Liuzzi,  Mondino,  127 
Livini,  Ferdinando,  160 
Livy,  138 

Locatelli,  Giuseppe,  172 
Longo,  229 

Loreta,  Pietro,  125,  173,  231 
de  Luca,  Domenico,  224 
da  Lucca,  Nicolo'  Cappelletti,  220 
Lunghi,  Antonio,  224 
Lustig,  Alessandro,  189,  217 
Luxardo,  Augusto,  234 
Luzzato,  A.  M.,  232 

da  Macerata,  Tarduccio  Salvi,  229 
Maffeo,  126 
Maffucci,  142,  233 
Magati,  Cesare,  96,  220 


246 


INDEX 


Maggi,  96 

Magni,  Egisto,  126 

Majocchi,  Andrea,  161 

Malagodi,  Luigi,  226 

Manfredini,  G.  B.,  226 

Mangiagalli,  Luigi,  94,  99,  100,  156, 

160,  234 
Malpighi,  Marcello,  106,  123,  127 
Mandolfi,  55 
Mantelli,  Candido,  169 
Maragliano,  Dario,  230,  234 
Maragliano,  Edoardo,  95 
Marchetti,  Pietro,  220,  232 
Marconi,  227 
Margarucci,  Oreste,  119 
Margary,  Fedele,  237 
Mariani,  Carlo,  233 
Marignano,  182 
Marinelli,  Giovanni,  234 
Marponi,  R.,  231 
Marrassini,  Alberto,  235 
Marro,  Andrea,  169 
Marsigli,  123 
Martini,  232 

Martino,  Bernardino,  233 
Marzolo,  224 
Mascagni,  Paolo,  106 
Masini,  Giulio,  99 
Massapust,  233 
Mastrosimone,  Francesco,  234 
Mattoli,  Aristide,  214,  232 
Mazzini,  Giacomo,  172 
Mazzini,  Giuseppe,  2,  10,  123,  130, 

163,  170 
Mazzoni,  Costanzo,  116 
Mazzoni,  Gaetano,  116,  120 
Mazzotti,  L.,  232 
Media,  Eugenio,  161 
Meirocco,  Vincenzo,  235 
Melchiori,  Giovanni,  235 
Meltzer,  133 
Menzel,  225 
Mercandino,  E.,  233 
Meyer,  Willy,  147 
Michelangelo,  188 


Michelazzi,  A.,  234 

Micheli,  232 

Mioni,  G.,  235 

Minaglia,  172 

Miranda,  Giovanni,  100 

Molinelli,  220,  232 

Molinetti,  224 

Monari,  Umberto,  94,  126,  232 

Mondino,  103,  104  ,  106 

Montanari,  126 

Monteggia,    Giovanni   Battista,   40, 

155, 156 
Montenovesi,  Vincenzo,  121,  233 
Montigore,  224 
Morelli,    Eugenio,    19,   42,   95,  119, 

150,  151,  152,  229 
Moreschi,  A.,  238 
Morgagni,  123,  229 
Moriconi,  Pietro,  178 
Morisani,  D.,  231,  233,  234 
Morone,  140 

Morpurgo,  Benedetto,  217 
Morron,  John,  25 
Morselli,  E.,  223 
Motta,  Mario,  226,  237 
Mugnai,  A,,  223,  232,  233 
Murphy,  230 
Murri,  Augusto,  95,  222 
Muscatello,  Giuseppe,  208 
Muscatello,  R.  226 

Nannoni,  Angiolo,  220,  228 

Nannotti,  A.,  223,  233 

Napoleon,  2,  146,  171 

Napoleon  III,  4 

da  Narni,  Erasmo,  140 

Nazari,  Alessio,  121 

Negretto,  Angelo,  237 

Nespoli,  Enrico,  235 

di  Netro,  Riccardi,  76 

Nicolaier,  167 

Nightingale,  Florence,  159 

Nigrisoli,  Bartolo,  34,  38,  42,  94,  125 

Ninni,  229,  230 

Nitti,  Francesco,  197 


INDEX 


247 


Nota,  Annibale,  224,  235 

Novaro,  Giacomo  Filippo,  94,  124, 
173.  174.  175.  218,  222,  223, 
226,    227,    229,    231,    234,    236 

Obalinski,  236 
Oliva,  Valentino,  168 
Ore,  G.  Dalle,  235 
Ortuani,  Arturo,  225 
Ottolenghi-Finzi,  90 

Paccinotti,  Giuseppe,  235 

Paci,  Giorgio,  234,  235 

Pacini,  Filippo,  106 

Padula,  Fabrizio,  196,  221 

Pagello,  Giusto,  227,  235 

Palletta,  Giovanni,  Battista,  40,  156, 

228,  238 
Palmieri,  126 
Pansini,  Sergio,  232 
Pantaleoni,  Carlo,  207,  232 
Panzeri,  Pietro,  80,  84,  156,  231 
Paolucci,  Gaetano,  232 
Parlavecchio,  Gaetano,  94,  206,  231, 

233 

Parona,  A.,  225,  226,  229,  233 

Parravicini,  223 

Parrini,  C.,  235 

Parrozzani,  229 

Pascale,  Giovanni,  195,  196,221,235 

Pasini,  161 

Patrini,  Guglielrao,  155 

Pavoni,  224 

Pecchioli,  Zanobi,  220 

Penzo,  Rodolfo,  221,  233 

Perez,  Giovanni,  149 

Perroncito,  Aldo,  211 

Peruzzi,  234 

Pesenti,  G.,  234 

Pestalozza,  Ernesto,  100,  119,  234 

Petrarca,  Francesco,  139 

Piazza,  Giuseppe,  207 

Piazza,  V.,  232 

Pietri,  Giovanni  Andrea,  212 


Pilcher,  Lewis  Stephen,  102 

Pini,  Gaetano,  79,  80,  126,  156 

Pisani,  Ugo,  235 

Petrone,  232 

Pirri,  Giovanni,  233 

Pisano,  Nicola,  140 

Pizzorno,  A.,  233 

Platschick,  Carlo,  160 

Poggi,   Alfonso,   94,    124,    125,   235, 

236 
Poli,  Camillo,  99 
Polverini,  Giovanni,  160 
Porro,  Edoardo,  99,  156,  234 
Porta,  Antonio,  147 
Postempski,    Paolo,    116,    121,    230, 

231.  233 
Potain,  151 
Potzu,  Francesco,  211 
Pousson,  211 
Pozza,  Pietro,  234 
Puccinotti,  Francesco,  102 
Puccinelli,  Vittorio,  120 
Pugliese,  Angelo,  233 
Putti,  Vittorio,  45,  59,  64,  71,  86,  94 

Quincke,  226 

Racco,  233 
Raffa,  A.,  233 
Raimondi,  230 
Ramoni,  229 
Ramusani,  126 
Ranuccio  I,  134,  135 
Ranzi,  220,  225 
Rasori,  156 

Ravaschieri,  Duchess,  87 
Razzaboni,  Giovanni,  214 
Reali,  Francesco,  235 
Realdo,  Matteo,  105 
Rebaudi,  L.,  238 
Regnoli,  Giorgio,  223,  225 
Remedi,  Vittorio,  185,  225 
de  Renzi,  Enrico,  95 
de  Renzi,  Salvatore,  102 


248 


INDEX 


Rho,  F.,  230 

Riberi,  220 

Ribotti,  Battista,  155 

Rieppi,  Luigi,  232 

Righetti,  Carlo,  214 

Rima,  Tommaso  G.,  40,  226,  238 

Rindone,  Santi,  208 

Ripamonti,  227 

Riva-Rocci,  Scipione,  153 

Rizzo,  Leopoldo,  195 

Rizzoli,  Francesco,  83,  86,  123,  220 

Rocco,  237 

Rolandi,  Silvio,  235 

Rolando,  Luigi,  106,  165 

Romiti,  Guglielmo,  179,  217 

Roncali,  Demetrio,  142 

Ronzano,  224 

Roosevelt,  Theodore,  10 

Rossi,  Baldo,  29,  38, 42, 126, 160, 161, 

234—237 
Rossini,  230 
Rossoni,  Eugenio,  121 
Rota,  82 

Roth,  Angelo,  195,  210,  211,  233 
Rouhald,  220 
Rovida,  Camillo,  160 
Rovighi,  A.,  234 
Rubegni,  214 
Ruggi,  Giuseppe,  93,  94,  99,  124,  226, 

227,  229,  232,  233,  234 

Sacchi,  Ercole,  222,  223,  227 

Saffi,  Aurelio,  123 

Salaghi,  237 

Salomoni,  Annibale,  223,  227,  232 

Salvolini,  E.,  232 

San  Felice,  142 

Sansovino,  140,  141 

Santarnecchi,  214 

Santorini,  Giovanni  Domenico,  106 

Sarti,  106 

Sauerbruch's,  72 

Saviozzi,  38,  39 

Scan,  Emilio,  222 

Scaliger,  141 


Scarpa,  Antonio,  106 

Schiassi,  Benedetto,  41,  126,  232,  238 

Schifone,  O,  235 

Segale,  J.  B.,  232 

Senna,  Giovanni  Battista,  155 

Serafini,  Giuseppe,  169 

Servetus,  141 

Settimo,  Ruggiero,  2 

Severino,  Marco  Aurelio,  220 

Sforza,  Lodovico,  145,  146 

Sgambati,  A.  232 

Sighinolfi,  126 

Sigurta,  161 

Silvestrini,  RaflFaello,  232 

Silvius,  141 

Sirleo,  142 

Sironi,  229 

Sivori,  172 

Soave,  Luigi,  232,  233 

Sobieski,  141 

Sodo,  230 

Solaro,  A.,  233 

Sorge,  G.,  230 

Sorrentino,  230 

Sottocasa,  L.,  234 

Spallanzani,  145 

Spallitta,  F.,  223 

Spangaro,    Saverio,  143 

Spencer- Wells,  194 

Stecchi,  Remigio,  233,  236 

di  Stefano,  Nunzio,  208 

Stewart,  George  David,  45 

Stori,  Theodoro,  191 

Story,  W.,  122 

Strambio,  Gaetano,  155,  156 

Symonds,  Margaret,  213 

Taddei,  Domenico,  185,  186,  187,  217 

Tagliacossi,  224 

Talma,  148 

Tamburini,  223 

Tansini,  Iginio,  94,  148,  149,  180,  205, 

223,  227,  233 
Tapparelli,  126 
Tarchetti,  Gaetano,  236 


INDEX 


249 


Taruffi,  Cesare,  128 

Tarugi,  126,  127 

Tassi,  229 

Tasso,  141 

Tedeschi,  G.,  233 

Terrile,  E.,  232 

Testi,  Francesco,  26 

Theodoric,  144,  145,  154 

Theodosius  II,  122 

Theresa,  Maria,  146 

Thompson,  Henry,  217 

Tiepolo,  140 

Tirahoschi,  A.,  237 

Titian,  140 

Titone,  Michele,  221,  232 

Tizzoni,  Guido,  14,  125,  224 

Tomaselli,  Vincenzo,  208 

Tomati,  Cristoforo,  172 

Tommasi,  216 

Torcello,  E.,  235 

Toscano,  Antonino,  217 

Totila,  139 

Trevelyan,  George,  10 

Trevisan,  Nicolo,  235 

Tricomi,  Ernesto,  94,  205,  227,  232, 

233 
Troja,  Michele,  227,  228 
Trombetta,  227 
Truzzi,  234 
Turrazza,  G.,  230,  234 
Turretta,  A.,  226,  233 
Tuscany,  Matilda  of,  134 
Tusini,  Giuseppe,  34,  94,  135,  136 
Tuzzi,  229 


Valsalva,  Antonio,  123,  127,  128,  220, 

229 
Vanghetti,  Giuliano,  45,  59,  60,  98, 

120,  180,  218 
Vanzetti,  141,  220,  223,  224,  226,  236 
Valerani,  224 

Varolio,  Costanzo,  105,  106,  127 
Vassale,  Giulio,  223,  227 
de  Vecchi,  Bindo,  232 
Velo,  Giovanni,  143,  234 
Verga,  Andrea,  156 
Veronese,  Paolo,  140,  219 
Vernicchi,  Tommaso,  230 
Vesalius,  Andreas,  96,  102,  127,  141 
Vianeo,  224 

Vico,  Giovanni  Battista,  193 
Vidal,  149 

della  Vigna,  Pier,  193 
Villani,  Giuseppe,  226 
da  Vinci,  Leonardo,  105 
Viola,  Giacinto,  232 
Virchow,  194 
Virdia,  Antonino,  235 
Virgil,  140 

Viscontini,  Carlo,  235 
Visconti,  Gian  Galeazzo,  145,  146 
Visconti,  Marchese,  79 
Vitali,  Fabio,  232 
Vivante,  223 
Volpi,  T.,  238 
Volta,  Alessandro,  145,  147 
von  Langenbeck,  194 
von  Recklinghausen,  208 
Vulpius,  Oscar,  87 


Ufferduzzi,  Ottorino,  169 

Ughetti,  232 

Umberto,  86 

Usiglio,  Gustavo,  225,  227,  232,  233 

Vacca-Berlinghieri,  220 
Valeggia,  Timoteo,  233 
Valerani,  Flavio,  98 
Valerio,  Siro,  156 


Walsh,  James  J.,  101 
Washington,  Booker  T.,  200 

Zambeccari,  123 

Zannetti,  Ferdinando,  221 

Zatti,  Cesare,  234 

Zenoni,  161 

Zoppi,  81 

Zurria,  Giovanni,  208 


DEC     8  1821 


Mode™J/.a(ian  surge-  —.  - . 


